Review of Nipple Reconstruction Techniques and Introduction of V to Y Technique in a Bilateral Wise Pattern Mastectomy or Reduction Mammaplasty

Introduction: Nipple-areola complex reconstruction (NAR) is the final procedure in breast reconstruction after the majority of mastectomies. Many methods of NAR have been described, each with inherent advantages and disadvantages depending on local healthy tissue availability, previous scarring and procedures, and the operative morbidity of the NAR technique. Nipple reconstructions may be complicated by scars or previous nipple reconstruction, making the procedure more challenging. We propose the use of the V-Y advancement flap as a new method that is suitable for both novice and experienced surgeons wishing to broaden their range of techniques for difficult nipple reconstructions. Methods: A traditional V-Y advancement flap is lifted at the site of the future nipple. Mastectomy scars from prior mastectomy, mammoplasty, or nipple reconstruction can be incorporated into the flap. The flap is folded caudally upon itself and the secondary defect at the apex of the flap is linearly closed. Results: At 6-month postoperative evaluation, adequate nipple projection and patient satisfaction were achieved with this method. Conclusion: The V-Y advancement flap is a suitable method for achieving satisfactory results when faced with challenging NAR. The method is easy to perform, reproducible, has low operative morbidity, and incorporates previous wise pattern mastectomy or mammaplasty scars into the newly reconstructed nipple, thereby decreasing new scar formation on the breast and leading to favorable cosmetic results.