eMedicine Specialties > Plastic Surgery > Breast

Breast Reconstruction, Nipple-Areola Reconstruction: Multimedia

Author: Yoon Sun Chun, MD, Clinical Instructor, Department of Surgery, Harvard Medical School; Associate Surgeon, Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital; Staff Surgeon, Department of Surgery, Division of Plastic and Reconstructive Surgery, Faulkner Hospital
Coauthor(s): Dennis P Orgill, MD, PhD, Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women's Hospital
Contributor Information and Disclosures

Updated: Aug 20, 2009

Multimedia

Diagram illustrating the layout of the bell flap....
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Media file 1: Diagram illustrating the layout of the bell flap. Note the triangles excised between the "handle" and the "bell" of the flap to allow for easier folding.
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Diagram illustrating the layout of the bell flap....

Diagram illustrating the layout of the bell flap. Note the triangles excised between the "handle" and the "bell" of the flap to allow for easier folding.

Diagram illustrating the layout of the skate flap...
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Media file 2: Diagram illustrating the layout of the skate flap. D is the diameter of the contralateral nipple, and the total length of the flap is twice the height (projection) of the contralateral nipple.
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Diagram illustrating the layout of the skate flap...

Diagram illustrating the layout of the skate flap. D is the diameter of the contralateral nipple, and the total length of the flap is twice the height (projection) of the contralateral nipple.

Diagram illustrating the layout of the double opp...
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Media file 3: Diagram illustrating the layout of the double opposing tab flap. Note that the minimum recommended base width for the tabs is 18 mm. The 2 tabs are elevated and rotated to face each other as if 2 hands were joined in prayer.
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Diagram illustrating the layout of the double opp...

Diagram illustrating the layout of the double opposing tab flap. Note that the minimum recommended base width for the tabs is 18 mm. The 2 tabs are elevated and rotated to face each other as if 2 hands were joined in prayer.

Intraoperative sequence of nipple reconstruction ...
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Media file 4: Intraoperative sequence of nipple reconstruction with the bell flap: initial layout and dissection of the flap.
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Intraoperative sequence of nipple reconstruction ...

Intraoperative sequence of nipple reconstruction with the bell flap: initial layout and dissection of the flap.

Intraoperative sequence of nipple reconstruction ...
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Media file 5: Intraoperative sequence of nipple reconstruction with the bell flap: elevation and initial apposition of the flap.
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Intraoperative sequence of nipple reconstruction ...

Intraoperative sequence of nipple reconstruction with the bell flap: elevation and initial apposition of the flap.

Intraoperative sequence of nipple reconstruction ...
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Media file 6: Intraoperative sequence of nipple reconstruction with the bell flap: final reconstruction.
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Intraoperative sequence of nipple reconstruction ...

Intraoperative sequence of nipple reconstruction with the bell flap: final reconstruction.

Diagram illustrating the layout of modified star ...
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Media file 7: Diagram illustrating the layout of modified star flap for nipple reconstruction. D is the diameter of the contralateral nipple. The 2 lateral arms wrap around to form a cylindrical structure and the central arm provides the top.
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Diagram illustrating the layout of modified star ...

Diagram illustrating the layout of modified star flap for nipple reconstruction. D is the diameter of the contralateral nipple. The 2 lateral arms wrap around to form a cylindrical structure and the central arm provides the top.

Intraoperative photograph of a nipple reconstruct...
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Media file 8: Intraoperative photograph of a nipple reconstruction using modified star flap. The 3-arm donor sites are closed primarily.
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Intraoperative photograph of a nipple reconstruct...

Intraoperative photograph of a nipple reconstruction using modified star flap. The 3-arm donor sites are closed primarily.

Postoperative photograph of the same patient.
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Media file 9: Postoperative photograph of the same patient.
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Postoperative photograph of the same patient.

Postoperative photograph of the same patient.

More on Breast Reconstruction, Nipple-Areola Reconstruction

Overview: Breast Reconstruction, Nipple-Areola Reconstruction
Treatment: Breast Reconstruction, Nipple-Areola Reconstruction
Follow-up: Breast Reconstruction, Nipple-Areola Reconstruction
Multimedia: Breast Reconstruction, Nipple-Areola Reconstruction
References
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References

  1. American Cancer Society. Cancer Statistics 2009 Presentation. American Cancer Society Web site. Available at http://www.cancer.org/docroot/PRO/content/PRO_1_1_Cancer_Statistics_2009_Presentation.asp. Accessed August 20, 2009.

  2. National Clearinghouse of Plastic Surgery Statistics. 2008 Reconstructive Breast Patients. 2009 Report of the 2008 Statistics. American Society of Plastic Surgeons Web site. Available at http://www.plasticsurgery.org/Media/stats/2008-US-cosmetic-reconstructive-plastic-surgery-minimally-invasive-statistics.pdf. Accessed August 20, 2009.

  3. Few JW, Marcus JR, Casas LA. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg. Oct 1999;104(5):1321-4. [Medline].

  4. Evans KK, Rasko Y, Lenert J. The use of calcium hydroxylapatite for nipple projection after failed nipple-areolar reconstruction: early results. Ann Plast Surg. Jul 2005;55(1):25-9; discussion 29. [Medline].

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  10. Kroll SS, Reece GP, Miller MJ. Comparison of nipple projection with the modified double-opposing tab and star flaps. Plast Reconstr Surg. May 1997;99(6):1602-5. [Medline].

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  13. Tanabe HY, Tai Y, Kiyokawa K. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg. Aug 1997;100(2):431-8. [Medline].

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  16. Di Benedetto G, Sperti V, Pierangeli M. A simple and reliable method of nipple reconstruction using a spiral flap made of residual scar tissue. Plast Reconstr Surg. Jul 2004;114(1):158-61. [Medline].

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  19. Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. Jul 2003;238(1):120-7. [Medline].

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  25. Bhatty MA, Berry RB. Nipple-areola reconstruction by tattooing and nipple sharing. Br J Plast Surg. Jul 1997;50(5):331-4. [Medline].

  26. Khoo A, Kroll SS, Reece GP. A comparison of resource costs of immediate and delayed breast reconstruction [see comments]. Plast Reconstr Surg. Apr 1998;101(4):964-8; discussion 969-70. [Medline].

  27. Kroll SS. Integrated breast mound reduction and nipple reconstruction with the wraparound flap. Plast Reconstr Surg. Sep 1999;104(3):687-93. [Medline].

  28. Williams EH, Fix RJ, Person DW, et al. Immediate nipple areolar reconstruction in the free TRAM breast reconstruction. In: Proceedings of the American Society of Reconstructive Microsurgeons Annual Meeting Program Book. 2006:144.

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Further Reading

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Keywords

breast reconstruction, nipple-areola complex, breast cancer, athelia, transverse rectus abdominus myocutaneous reconstruction, TRAM reconstruction, microvascular-free TRAM breast reconstruction, mastectomy, breast surgery, breast implant, nipple surgery, nipple reconstruction, areola reconstruction

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Contributor Information and Disclosures

Author

Yoon Sun Chun, MD, Clinical Instructor, Department of Surgery, Harvard Medical School; Associate Surgeon, Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital; Staff Surgeon, Department of Surgery, Division of Plastic and Reconstructive Surgery, Faulkner Hospital
Yoon Sun Chun, MD is a member of the following medical societies: American Medical Association, American Society of Plastic Surgeons, Association of Women Surgeons, Johns Hopkins Medical and Surgical Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Dennis P Orgill, MD, PhD, Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women's Hospital
Dennis P Orgill, MD, PhD is a member of the following medical societies: American Burn Association, American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council
Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Isologen Corporation Grant/research funds Principle Investigator; Massachusetts Institute of Technology Royalty None; Brigham and Women's Hospital Royalty None; Regenesis Corporation Scientific Advisory Board Consulting; Kinetic Concepts, Inc. Expert Witness None

Medical Editor

Pankaj Tiwari, MD, Assistant Professor, Division of Plastic Surgery, Ohio State University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Saleh M Shenaq, MD†, Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston
Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law Medicine and Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

James Neal Long, MD, Assistant Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, University of Alabama at Birmingham and Kirklin Clinics
James Neal Long, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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