The top hat flap: for one stage reconstruction of a prominent nipple

Nipple reconstruction is an important adjunctive procedure in breast reconstruction. Local flap procedures and tattoo-only techniques rarely provide sufficient projection in a patient with prominent nipples. We describe a method to reconstruct such a nipple termed the top hat flap. A retrospective chart review of 38 patients was performed to determine adequacy of projection and complication rates of 46 nipples created between 1989 and 1994. Forty-three (93%) of the nipples resulted in adequate and sustained projection at a minimum of 1-year follow-up. The complication rate was found to be low and patient satisfaction high with this simple outpatient procedure.