Results of nipple reconstruction using the modified double opposing tab flap technique

Abstract EN

Objective : Nipple-areola reconstruction represents the final stage of breast reconstruction.

Many nipple reconstruction techniques are available using either local flaps or free composite grafts.

Maintenance of nipple projection has always been the biggest problem with the various techniques.

We report our results with nipple reconstruction using the modified double-opposing tab (MDOT) flap technique as described by Kroll that we have been using for the past three years.

Methods : Because nipple projection tends to decrease for several months after reconstruction with any technique, only patients with a follow-up of at least three months after nipple reconstruction were included in the analysis.

Over the last three years 28 patients underwent 31 nipple reconstructions using the modified double-opposing tab flap technique (one bilateral and two revisions) at King Hussein Medical Centre and King Hussein Cancer Centre.

All 28 patients had previous breast reconstructions by the authors at least three months prior to the nipple reconstruction ; 12 patients had had immediate reconstruction and 16 patients had delayed reconstruction.

The outline of the areola was defined with a round template in an appropriate location and the modified double-opposing tab flaps were raised within this circle.

The axis of the flaps varied with the location of the breast scars.

Donor sites were primarily closed and all resulting scars contained within the planned areola so as to be completely camouflaged by later intradermal tattoo to be performed four months postoperatively.

All but five cases that required surgery on the other breast were done under local anesthesia.

Results : Age range was 28-55 years (mean 39.5 yrs).

The duration of the procedure varied from 30-45 minutes.

Three nipples in the series suffered partial necrosis from ischemia of which two needed revisions due to loss of projection.

The third nipple healed spontaneously and maintained adequate projection.

All three complications occurred in the first five patients and were due to inexperience with the technique.

The average reduction of projection at three months was 48.3% of the original projection.

All patients were satisfied with the final projection and symmetry.

Conclusion : The technique is simple and permits freedom in choosing the height of the nipple, even in the presence of scars.

The dissection is straightforward and the technique is rapid with few complications after a short learning curve.