Nipple Reconstruction with the Double Opposing Plow Flap: A Case Report

Purpose: Nipple reconstruction is an important step in breast reconstruction after mastectomy. There are considerable number of reconstructive methods developed over the past years. Each of these has not only its own special advantages, but also limitations. Therefore, no single method has become the overwhelming favorite. Sometimes it seems to be compromised when the nipple must be located directly over a linear scar. Methods: A 48-year-old female patient received a central lumpectomy with circumareolar resection of the nipple areolar complex 4 months ago. The newly designed nipple must be positioned directly astride a scar. We drew two equal-sized rectangular flaps sharing a common limb on a transverse scar and the result was two opposing plow form. Each flap size was about 1.3 cm wide and 2.5 cm long. First we elevated the flap from the distal part at a deep dermal plane, then deepened the level of dissection to raise the dermal-fat flaps. The donor site could be closed directly without any dog-ear deformity. Then we folded down the elevated flaps and loosely sutured skin with nonabsorbable materials. Each flap inner side was approximated side by side. Finally we made new natural nipple with 6 mm projection. We applied tattooing in the areola area with micropigmentation device after three months. Results: After ten months of follow-up periods, the nipple projection was stable and symmetric. The nipple projection was 3.1 mm, compared with 2.8 mm for the opposite nipple. Conclusion: Our experiences shows that this double opposing plow flap is a particularly useful and simple technique when there is a traverse scar crossing the center of the proposed nipple area.

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