Augmentation of the Nipples Reconstructed with Modified Top-Hat Flap Using Dermal Grafts in Implant-Based Breast Reconstruction: A Comparative Study.

BACKGROUND: Nipple reconstruction in implant-based breast reconstruction remains challenging, as the remaining thin skin envelope results in a less projected neo-nipple with a reduced volume. This study presents a modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings for augmenting reconstructed nipples during implant-based breast reconstruction.

METHODS: Between April 2011 and December 2014, among 34 patients who underwent immediate post-mastectomy reconstruction with a direct silicone implant, nipple reconstruction was performed using the modified top-hat flap technique in only 21 patients (group A), whereas 13 patients underwent the modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings (group B). The projection and width of the neo-nipple were measured at the time of surgery and at 1 year post-surgery, respectively.

RESULTS: All modified top-hat flaps were successful without any complications. The mean nipple projections at the time of surgery were 0.75 ± 0.107 cm (range 0.5-0.9 cm) and 1.29 ± 0.064 cm (range 1.2-1.4 cm) in groups A and B, respectively (p < 0.001). The mean nipple widths at the time of surgery were 0.90 ± 0.184 cm (range 0.6-1.2 cm) and 1.43 ± 0.076 cm (range 1.3-1.5 cm) in groups A and B, respectively (p < 0.001). The maintenance of nipple projection and width was significantly increased in group B compared with group A.

CONCLUSION: The modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings is a useful and easy method to expand and augment the volume of reconstructed nipples in implant-based breast reconstruction.

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