Bell flap nipple reconstruction—a new wrinkle

J S Eng
Annals of Plastic Surgery 1996, 36 (5): 485-8
This single-stage nipple reconstruction technique is designed to produce a properly pigmented nipple-areolar complex that projects well above the breast mound without the need of skin grafts. The basic design of this technique consists of a bell-shaped random pattern flap within a circular subcutaneous island flap. The bell-shaped flap is incised, undermined, elevated, and folded into the shape of an inverted box, forming the new nipple. The remainder of the circular island flap is circumferentially incised, partially undermined, and sutured into a flat cone, forming the new areola. The nipple is inset in the center of this cone, completing the new nipple-areolar complex. This complex is then squeezed and pushed forward by the closure of a purse string suture placed on the raw edge of the outer skin circle. Predetermined pigments are tattooed immediately prior to the skin incisions and Montgomery's tubercles can be added after the pursestring closure by high-temperature cautery or biopsy punch. This technique has been attempted on six nipples in 5 patients for breast mounds reconstructed by musculocutaneous flaps or from breast reductions with satisfactory-to-good results in the past 2 1/2 years. However, at this time, it has not been, nor should it be attempted on breast mounds reconstructed solely by implants, due to unpredictable subcutaneous blood supply.

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