The Delta flap technique: Expanding nipple reconstruction options for central post-mastectomy scars

Nipple-areola complex reconstruction (NAR) has gained increasing popularity, allowing the accomplishment of esthetic breast reconstructions. To date, none of the currently available techniques has apparently achieved satisfactory outcomes on previous mastectomy scars. With Delta flap, we aimed to provide an alternative solution for proper long-term projection and nipple positioning in such challenging cases.

We prospectively enrolled patients scheduled for NAR at our site. Delta flap was used when mastectomy scars crossed the intended neo-nipple site (group A) and compared with a control group (B) where C-V flaps nipple reconstructions were performed. Loss of projection was calculated for both groups, comparing immediate and 6-month postoperative projections. Analysis of operative times and complications was performed using the Student t-test with Welch correction. Chi-square test was used to assess patients' and surgeons' esthetic outcomes.

Twenty-five nipples were included in each group. A minimal difference was registered in long-term projection between the 2 groups; besides, loss of projection at 6 months was significantly reduced in group A (40.39%±0.12; p=0.042). No statistically significant differences were found regarding operative times (p=0.385) and complications (p=0.637). Surgeons assessed symmetry with the contralateral nipple and found that it improved in the active group (p=0.023), plus group A patients were more likely to recommend the procedure (p=0.015).

Delta flap represents an innovative tool addressing NAR when the planned neo-nipple site has consolidated scars that compromise the achievement of adequate reconstructive outcomes. With a few simple modifications, it provides optimal nipple positioning, long-term projection, and reduced morbidity compared to traditional methods.