Hybrid C-V and Star Flap Technique for Nipple Reconstruction: A Case Report

Nipple-areola complex (NAC) reconstruction is the final step in breast reconstruction and significantly influences aesthetic outcome and patient satisfaction. Progressive loss of nipple projection remains a persistent challenge despite numerous local flap techniques. We present a hybrid technique combining C-V and star flaps to enhance central bulk, support projection, and preserve vascularity. A 28-year-old woman underwent bilateral NAC reconstruction three months after implant-based breast reconstruction for hypoplasia. The reconstructed nipples healed without flap necrosis or other complications, with preserved symmetry, and the patient was satisfied with the outcome; some reduction in projection was noted over the follow-up period, although projection was not objectively measured. By integrating the volumetric advantage of the star flap with the vascular reliability of the C-V flap and adding a de-epithelialized triangular dermal component, this hybrid design was technically feasible and produced a satisfactory short-term result. As with established techniques, early projection loss may occur; whether the design offers any advantage in projection retention cannot be determined from a single short-term case and requires comparative study with objective measurement and longer follow-up.