Nipple Reconstruction Using the C-V Flap Technique: A Long-Term Evaluation

Abstract

Numerous procedures are available for nipple reconstruction with no true universal favorite. This study presents long-term follow-up data for nipple reconstruction using the C-V flap technique. Patients were identified by searching the Breast Reconstruction Database, and they were asked to return for a follow-up visit. All those who underwent nipple reconstruction using the C-V flap technique between January of 1992 and December of 1996 were reviewed in an attempt to conduct a long-term follow-up evaluation. The response was poor, and 11 patients participated in the study and returned for follow-up. They all completed a questionnaire, which focused on patient satisfaction using a visual analogue scale. Nipple measurements were taken with a caliper and compared with the opposite breast for symmetry. Fourteen nipple reconstructions were evaluated in 11 patients with an average follow-up of 5.3 years. All patients had undergone transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions. Patient satisfaction was 42 percent with nipple projection, 62 percent with pigmentation, and 26 percent with sensation. Overall patient satisfaction with the procedure was 81 percent. Average nipple projection of the reconstructed nipple was 3.77 mm and was not statistically different when compared with the opposite nipple. Long-term subjective evaluation of the C-V flap technique does report a loss in nipple projection; however, overall patient satisfaction at 5.3 years is good, as is the ability to restore symmetry with the opposite breast.

Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis

“…Reasons authors cited for favoring this flap included its ease, consistency, reliability and lack of donor site morbidity (14,19,22,23). With the high satisfaction seen regardless of technique, however, factors such as surgeon preference and experience should be considered when choosing a nipple reconstruction technique.…”

“…More often, however, local tissue rearrangement is used to create a nipple, followed by tattooing of the reconstructed nipple and the surrounding skin that is to become the areola. A variety of local flaps has been described in the literature (1,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

A Modified Technique for Nipple-Areola Complex Reconstruction

“…[1] We share the opinion of others that creation of the nipple transforms the reconstructed breast mound into a breast. [10][11][12][13] Several nipple reconstruction techniques that use grafts or flaps have been reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] They give comparable and satisfactory short-term results, but these worsen over time, with a loss of projection, invagination and a relative widening of the base.…”

“…[10][11][12] A bandage should not compress the neonipple because this contributes to its secondary height loss. A soft plastic splint ensures a provisional protection of the nipple for approximately 3 months postoperatively.…”

The angel flap for nipple reconstruction

“…Paramount among these limitations is the loss of projection seen with all local flap techniques. Objective measures assessing long-term nipple projection in the literature are sparse; however, studies that have evaluated long-term follow-up cite a loss of projection of 40% or more (Table 1) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). This problem has led many to advocate creating overprojection of the nipple to at least 150% of the contralateral side to allow for loss of projection.…”