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J Reconstr Microsurg 2010; 26(9): 589-600
DOI: 10.1055/s-0030-1263290
© Thieme Medical Publishers

Surgical Correction and Reconstruction of the Nipple-Areola Complex: Current Review of Techniques

Mark A. Boccola1 , Jessica Savage1 , Warren M. Rozen1 , Mark W. Ashton1 , Chris Milner1 , Richard Rahdon1 , Iain S. Whitaker1
  • 1Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy, University of Melbourne, Victoria, Australia
Further Information

Publication History

Publication Date:
18 August 2010 (online)

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ABSTRACT

Nipple malformations are common congenital or acquired conditions that can have tremendous cosmetic, psychological, breast-feeding, sexual, and hygienic ramifications. Ideal reconstruction of the nipple-areola complex (NAC) requires symmetry in position, size, shape, texture, pigmentation, and permanent projection, and although many technical descriptions of NAC reconstruction exist in the medical literature, there are insufficient data presented to accurately compare outcomes. The current article comprises a thorough review of the literature, exploring the techniques described for NAC reconstruction, comparing reported outcomes and complications, and providing an evidence-based approach to NAC reconstruction. The findings of the review suggest that evidence regarding surgical correction of nipple deformity and complete NAC reconstruction is lacking, and loss of nipple projection over time is a pervasive problem common to all flap techniques. A combination of a single pedicle local flap with tattooing for complete NAC reconstruction is currently the most supported method; however, data concerning which type of reconstruction is best suited to immediate versus delayed and type of breast mound remain to be examined.

KEYWORDS

Nipple areola complex - breast - reconstruction - autologous - aesthetic

REFERENCES

  • 1 Farhadi J, Maksvytyte G K, Schaefer D J, Pierer G, Scheufler O. Reconstruction of the nipple-areola complex: an update.  J Plast Reconstr Aesthet Surg. 2006;  59(1) 40-53
    CrossrefPubMedGoogle Scholar
  • 2 Kroll S S, Reece G P, Miller M J et al.. Comparison of nipple projection with the modified double-opposing tab and star flaps.  Plast Reconstr Surg. 1997;  99(6) 1602-1605
    CrossrefPubMedGoogle Scholar
  • 3 Crestinu J M. The correction of inverted nipples without scars: 17 Years' experience, 452 operations.  Aesthetic Plast Surg. 2000;  24(1) 52-57
    CrossrefPubMedGoogle Scholar
  • 4 Serra-Renom J, Fontdevila J, Monner J. Correction of the inverted nipple with an internal 5-point star suture.  Ann Plast Surg. 2004;  53(3) 293-296
    CrossrefPubMedGoogle Scholar
  • 5 Caviggioli F, Ventura D, Andretto Amodeo C, Klinger F. Inverted nipple: use of an effective and personalized splint after surgical correction with Pitanguy's technique to avoid relapse of the inversion in 28 cases.  Plast Reconstr Surg. 2008;  121(3) 139e-140e
    CrossrefPubMedGoogle Scholar
  • 6 Kolker A R, Torina P J. Minimally invasive correction of inverted nipples: a safe and simple technique for reliable, sustainable projection.  Ann Plast Surg. 2009;  62(5) 549-553
    CrossrefPubMedGoogle Scholar
  • 7 Chen S H, Gedebou T, Chen P H. The endoscope as an adjunct to correction of nipple inversion deformity.  Plast Reconstr Surg. 2007;  119(4) 1178-1182
    CrossrefPubMedGoogle Scholar
  • 8 Crestinu J M. Inverted nipple: the new method of correction.  Aesthetic Plast Surg. 1989;  13(3) 189-197
    CrossrefPubMedGoogle Scholar
  • 9 Lee H B, Roh T S, Chung Y K, Kim S W, Kim J B, Shin K S. Correction of inverted nipple using strut reinforcement with deepithelialized triangular flaps.  Plast Reconstr Surg. 1998;  102(4) 1253-1258
    CrossrefPubMedGoogle Scholar
  • 10 Lee K Y, Cho B C. Surgical correction of inverted nipples using the modified Namba or Teimourian technique.  Plast Reconstr Surg. 2004;  113(1) 328-336 discussion 337-338
    CrossrefPubMedGoogle Scholar
  • 11 Megumi Y. Correction of inverted nipple with periductal fibrous flaps.  Plast Reconstr Surg. 1991;  88(2) 342-346
    CrossrefPubMedGoogle Scholar
  • 12 Teimourian B, Adham M N. Simple technique for correction of inverted nipple.  Plast Reconstr Surg. 1980;  65(4) 504-506
    CrossrefPubMedGoogle Scholar
  • 13 Pompei S, Tedesco M. A new surgical technique for the correction of the inverted nipple.  Aesthetic Plast Surg. 1999;  23(5) 371-374
    CrossrefPubMedGoogle Scholar
  • 14 Aiache A. Surgical repair of the inverted nipple.  Ann Plast Surg. 1990;  25(6) 457-460
    CrossrefPubMedGoogle Scholar
  • 15 Min K H, Park S S, Heo C Y, Min K W. Scar-free technique for inverted-nipple correction.  Aesthetic Plast Surg. 2010;  34(1) 116-119
    CrossrefPubMedGoogle Scholar
  • 16 Ritz M, Silfen R, Morgan D, Southwick G. Simple technique for inverted nipple correction.  Aesthetic Plast Surg. 2005;  29(1) 24-27
    CrossrefPubMedGoogle Scholar
  • 17 Yamamoto Y, Furukawa H, Oyama A et al.. Two innovations of the star-flap technique for nipple reconstruction.  Br J Plast Surg. 2001;  54(8) 723-726
    CrossrefPubMedGoogle Scholar
  • 18 el Sharkawy A G. A method for correction of congenitally inverted nipple with preservation of the ducts.  Plast Reconstr Surg. 1995;  95(6) 1111-1114
    CrossrefPubMedGoogle Scholar
  • 19 Basile F V, Chang Y C. The triple-flap nipple-reduction technique.  Ann Plast Surg. 2007;  59(3) 260-262
    CrossrefPubMedGoogle Scholar
  • 20 Lai Y L, Weng C J, Noordhoff M S. Areolar reduction with inner doughnut incision.  Plast Reconstr Surg. 1998;  101(6) 1695-1699
    CrossrefPubMedGoogle Scholar
  • 21 Vecchione T. The reduction of the hypertrophic nipple.  Aesthetic Plast Surg. 1979;  3 343-345
    CrossrefPubMedGoogle Scholar
  • 22 Marshall K A, Wolfort F G, Cochran T C. Surgical correction of nipple hypertrophy in male gynecomastia: case report.  Plast Reconstr Surg. 1977;  60(2) 277-279
    CrossrefPubMedGoogle Scholar
  • 23 Regnault P. Nipple hypertrophy. A physiologic reduction by circumcision.  Clin Plast Surg. 1975;  2(3) 391-396
    PubMedGoogle Scholar
  • 24 Lai Y L, Wu W C. Nipple reduction with a modified circumcision technique.  Br J Plast Surg. 1996;  49(5) 307-309
    CrossrefPubMedGoogle Scholar
  • 25 Sperli A E. Cosmetic reduction of the nipple with functional preservation.  Br J Plast Surg. 1974;  27(1) 42-43
    CrossrefPubMedGoogle Scholar
  • 26 Ferreira L M, Neto M S, Okamoto R H, Andrews J de M. Surgical correction of nipple hypertrophy.  Plast Reconstr Surg. 1995;  95(4) 753-754
    CrossrefPubMedGoogle Scholar
  • 27 Cheng M H, Smartt J M, Rodriguez E D, Ulusal B G. Nipple reduction using the modified top hat flap.  Plast Reconstr Surg. 2006;  118(7) 1517-1525
    CrossrefPubMedGoogle Scholar
  • 28 O'Donnell M AHJ. What does the patient consider the important features of the reconstructed nipple and the donor nipple?. Winter Meeting of the British Association of Plastic Surgeons December 1, 1994 London;
    PubMedGoogle Scholar
  • 29 Little J W. Cryopreserved autologous nipple-areola complex transfer to the reconstructed breast.  Plast Reconstr Surg. 2003;  111 148
    CrossrefPubMedGoogle Scholar
  • 30 Nakagawa T, Yano K, Hosokawa K. Cryopreserved autologous nipple-areola complex transfer to the reconstructed breast.  Plast Reconstr Surg. 2003;  111(1) 141-147 discussion 148-149
    CrossrefPubMedGoogle Scholar
  • 31 Broadbent T R, Woolf R M, Metz P S. Restoring the mammary areola by a skin graft from the upper inner thigh.  Br J Plast Surg. 1977;  30(3) 220-222
    PubMedGoogle Scholar
  • 32 Adams W M. Labial transplant for correction of loss of the nipple.  Plast Reconstr Surg (1946). 1949;  4(3) 295-298
    CrossrefPubMedGoogle Scholar
  • 33 Hartrampf Jr C R, Culbertson J H. A dermal-fat flap for nipple reconstruction.  Plast Reconstr Surg. 1984;  73(6) 982-986
    CrossrefPubMedGoogle Scholar
  • 34 Ng S, Tan B K, Sharma N, Leow M, Sim R, Song C. Use of anodermal tissue for nipple reconstruction following breast reconstruction. ESPRAS (European Societies of Plastic, Reconstructive and Aesthetic Surgery) 10th Congress 2005 August 30, 2005 Vienna;
    PubMedGoogle Scholar
  • 35 Bhatty M A, Berry R B. Nipple-areola reconstruction by tattooing and nipple sharing.  Br J Plast Surg. 1997;  50(5) 331-334
    CrossrefPubMedGoogle Scholar
  • 36 Hugo N E, Sultan M R, Hardy S P. Nipple-areola reconstruction with intradermal tattoo and double-opposing pennant flaps.  Ann Plast Surg. 1993;  30(6) 510-513
    CrossrefPubMedGoogle Scholar
  • 37 Dean N R, Neild T, Haynes J, Goddard C, Cooter R D. Fading of nipple-areolar reconstructions: the last hurdle in breast reconstruction?.  Br J Plast Surg. 2002;  55(7) 574-581
    CrossrefPubMedGoogle Scholar
  • 38 Hammond D C, Khuthaila D, Kim J. The skate flap purse-string technique for nipple-areola complex reconstruction.  Plast Reconstr Surg. 2007;  120(2) 399-406
    CrossrefPubMedGoogle Scholar
  • 39 Little J. Nipple-Areolar Reconstruction. Boston; Little, Brown 1994
    PubMedGoogle Scholar
  • 40 Bogue D P, Mungara A K, Thompson M, Cederna P S. Modified technique for nipple-areolar reconstruction: a case series.  Plast Reconstr Surg. 2003;  112(5) 1274-1278
    CrossrefPubMedGoogle Scholar
  • 41 Anton M, Eskenazi L B, Hartrampf C R. Nipple reconstruction with local flaps: star and wrap flaps.  Perspect Plast Surg. 1991;  5 67
    PubMedGoogle Scholar
  • 42 Wong R K, Banducci D R, Feldman S, Kahler S H, Manders E K. Pre-reconstruction tattooing eliminates the need for skin grafting in nipple areolar reconstruction.  Plast Reconstr Surg. 1993;  92(3) 547-549
    CrossrefPubMedGoogle Scholar
  • 43 Jones G, Bostwick J. Nipple-areolar reconstruction.  Oper Tech Plast Reconstr Surg. 1993;  92 547
    PubMedGoogle Scholar
  • 44 Little III J W, Munasifi T, McCulloch D T. One-stage reconstruction of a projecting nipple: the quadrapod flap.  Plast Reconstr Surg. 1983;  71(1) 126-133
    PubMedGoogle Scholar
  • 45 Shestak K C, Gabriel A, Landecker A, Peters S, Shestak A, Kim J. Assessment of long-term nipple projection: a comparison of three techniques.  Plast Reconstr Surg. 2002;  110(3) 780-786
    CrossrefPubMedGoogle Scholar
  • 46 Eng J S. Bell flap nipple reconstruction—a new wrinkle.  Ann Plast Surg. 1996;  36(5) 485-488
    CrossrefPubMedGoogle Scholar
  • 47 Weiss J, Herman O, Rosenberg L, Shafir R. The S nipple-areola reconstruction.  Plast Reconstr Surg. 1989;  83(5) 904-906
    CrossrefPubMedGoogle Scholar
  • 48 Chang W H. Nipple reconstruction with a T flap.  Plast Reconstr Surg. 1984;  73(1) 140-143
    CrossrefPubMedGoogle Scholar
  • 49 Hallock G G, Altobelli J A. Cylindrical nipple reconstruction using an H flap.  Ann Plast Surg. 1993;  30(1) 23-26
    CrossrefPubMedGoogle Scholar
  • 50 Cohen I K, Ward J A, Chandrasekhar B. The pinwheel flap nipple and barrier areola graft reconstruction.  Plast Reconstr Surg. 1986;  77(6) 995-999
    CrossrefPubMedGoogle Scholar
  • 51 Guerra A B, Khoobehi K, Metzinger S E, Allen R J. New technique for nipple areola reconstruction: arrow flap and rib cartilage graft for long-lasting nipple projection.  Ann Plast Surg. 2003;  50(1) 31-37
    CrossrefPubMedGoogle Scholar
  • 52 Yanaga H. Nipple-areola reconstruction with a dermal-fat flap: technical improvement from rolled auricular cartilage to artificial bone.  Plast Reconstr Surg. 2003;  112(7) 1863-1869
    CrossrefPubMedGoogle Scholar
  • 53 Mukherjee R P, Gottlieb V, Hacker L. Nipple-areolar reconstruction with buried dermal hammock technique.  Ann Plast Surg. 1987;  19(5) 421-423
    CrossrefPubMedGoogle Scholar
  • 54 Di Benedetto G, Sperti V, Pierangeli M, Bertani A. A simple and reliable method of nipple reconstruction using a spiral flap made of residual scar tissue.  Plast Reconstr Surg. 2004;  114(1) 158-161
    CrossrefPubMedGoogle Scholar
  • 55 Little III J W. Nipple-areola reconstruction.  Clin Plast Surg. 1984;  11(2) 351-364
    PubMedGoogle Scholar
  • 56 Cao Y L, Lach E, Kim T H, Rodríguez A, Arévalo C A, Vacanti C A. Tissue-engineered nipple reconstruction.  Plast Reconstr Surg. 1998;  102(7) 2293-2298
    CrossrefPubMedGoogle Scholar
  • 57 Shestak K C, Nguyen T D. The double opposing periareola flap: a novel concept for nipple-areola reconstruction.  Plast Reconstr Surg. 2007;  119(2) 473-480
    CrossrefPubMedGoogle Scholar
  • 58 Little J. Nipple-Areolar Reconstruction. Chicago; Year Book Medical Publishers 1987
    PubMedGoogle Scholar
  • 59 Alfano C, Tenna S, Caggiati A, Campanella A. Nipple reconstruction by local flaps: a long-term comparative study between star and skate techniques.  Acta Chir Plast. 2004;  46 127-131
    PubMedGoogle Scholar
  • 60 Motamed S, Davami B. Postburn reconstruction of nipple-areola complex.  Burns. 2005;  31(8) 1020-1024
    CrossrefPubMedGoogle Scholar
  • 61 Valdatta L, Montemurro P, Tamborini F, Fidanza C, Gottardi A, Scamoni S. Our experience of nipple reconstruction using the C-V flap technique: 1 year evaluation.  J Plast Reconstr Aesthet Surg. 2009;  62(10) 1293-1298
    CrossrefPubMedGoogle Scholar
  • 62 Losken A, Mackay G J, Bostwick III J. Nipple reconstruction using the C-V flap technique: a long-term evaluation.  Plast Reconstr Surg. 2001;  108(2) 361-369
    CrossrefPubMedGoogle Scholar
  • 63 El-Ali K, Dalal M, Kat C C. Modified C-V flap for nipple reconstruction: our results in 50 patients.  J Plast Reconstr Aesthet Surg. 2009;  62(8) 991-996
    CrossrefPubMedGoogle Scholar
  • 64 Spyropoulou G A, Sterne G D. Algorithm for an aesthetically pleasing nipple-areola complex with the use of the C-V flap in cases of skin-sparing mastectomy and immediate reconstruction.  Aesthetic Plast Surg. 2009;  33(2) 240-242
    CrossrefPubMedGoogle Scholar
  • 65 Eo S, Kim S S, Da Lio A L. Nipple reconstruction with C-v flap using dermofat graft.  Ann Plast Surg. 2007;  58(2) 137-140
    CrossrefPubMedGoogle Scholar
  • 66 Weinfeld A B, Somia N, Codner M A. Purse-string nipple areolar reconstruction.  Ann Plast Surg. 2008;  61(4) 364-367
    CrossrefPubMedGoogle Scholar
  • 67 Few J W, Marcus J R, Casas L A, Aitken M E, Redding J. Long-term predictable nipple projection following reconstruction.  Plast Reconstr Surg. 1999;  104(5) 1321-1324
    CrossrefPubMedGoogle Scholar
  • 68 Rubino C, Dessy L A, Posadinu A. A modified technique for nipple reconstruction: the ‘arrow flap’.  Br J Plast Surg. 2003;  56(3) 247-251
    CrossrefPubMedGoogle Scholar
  • 69 Banducci D R, Le T K, Hughes K C. Long-term follow-up of a modified Anton-Hartrampf nipple reconstruction.  Ann Plast Surg. 1999;  43(5) 467-469 discussion 469-470
    CrossrefPubMedGoogle Scholar
  • 70 Klatsky S A, Manson P N. Toe pulp free grafts in nipple reconstruction.  Plast Reconstr Surg. 1981;  68(2) 245-248
    CrossrefPubMedGoogle Scholar
  • 71 Hasham S, Whitaker I S, Matteucci P, Fourie Le R. Prospective audit of free toe pulp grafts in nipple reconstruction. ESPRAS (European Societies of Plastic, Reconstructive and Aesthetic Surgery) 10th Congress August 30–September 3, 2005 Vienna;
    PubMedGoogle Scholar
  • 72 Whitaker I SHS, Matteucci P, Fourie Le R. An algorithm for nipple-areola reconstruction. ESPRAS (European Societies of Plastic, Reconstructive and Aesthetic Surgery) 10th Congress August 30–September 3, 2005 Vienna;
    PubMedGoogle Scholar
  • 73 Amarante J T, Santa-Comba A, Reis J, Malheiro E. Halux pulp composite graft in nipple reconstruction.  Aesthetic Plast Surg. 1994;  18(3) 299-300
    CrossrefPubMedGoogle Scholar
  • 74 Wong R K, Wichterman L, Parson S D. Skin sparing nipple reconstruction with polytetrafluoroethylene implant.  Ann Plast Surg. 2008;  61(3) 256-258
    CrossrefPubMedGoogle Scholar
  • 75 Panettiere P, Marchetti L, Accorsi D. Filler injection enhances the projection of the reconstructed nipple: an original easy technique.  Aesthetic Plast Surg. 2005;  29(4) 287-294
    CrossrefPubMedGoogle Scholar
  • 76 Evans K K, Rasko Y, Lenert J, Olding M. The use of calcium hydroxylapatite for nipple projection after failed nipple-areolar reconstruction: early results.  Ann Plast Surg. 2005;  55(1) 25-29 discussion 29
    CrossrefPubMedGoogle Scholar
  • 77 Garramone C E, Lam B. Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection.  Plast Reconstr Surg. 2007;  119(6) 1663-1668
    CrossrefPubMedGoogle Scholar
  • 78 Niechajev I, Sevćuk O. Long-term results of fat transplantation: clinical and histologic studies.  Plast Reconstr Surg. 1994;  94(3) 496-506
    CrossrefPubMedGoogle Scholar
  • 79 Laronga C, Kemp B, Johnston D, Robb G L, Singletary S E. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy.  Ann Surg Oncol. 1999;  6(6) 609-613
    CrossrefPubMedGoogle Scholar
  • 80 Beegle Jr P H. Immediate single-stage TRAM and nipple-areola reconstruction.  Clin Plast Surg. 1994;  21(2) 321-326
    PubMedGoogle Scholar
  • 81 Toth B A, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.  Plast Reconstr Surg. 1991;  87(6) 1048-1053
    CrossrefPubMedGoogle Scholar
  • 82 Andersen J A, Gram J B, Pallesen R M. Involvement of the nipple and areola in breast cancer. Value of clinical findings.  Scand J Plast Reconstr Surg. 1981;  15(1) 39-42
    CrossrefPubMedGoogle Scholar
  • 83 Parry R G, Cochran Jr T C, Wolfort F G. When is there nipple involvement in carcinoma of the breast?.  Plast Reconstr Surg. 1977;  59(4) 535-537
    PubMedGoogle Scholar
  • 84 Menon R S, van Geel A N. Cancer of the breast with nipple involvement.  Br J Cancer. 1989;  59(1) 81-84
    CrossrefPubMedGoogle Scholar
  • 85 Simmons R M, Brennan M, Christos P, King V, Osborne M. Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved?.  Ann Surg Oncol. 2002;  9(2) 165-168
    CrossrefPubMedGoogle Scholar
  • 86 Wirth R, Banic A, Erni D. Aesthetic outcome and oncological safety of nipple-areola complex replantation after mastectomy and immediate breast reconstruction.  J Plast Reconstr Aesthet Surg. 2009;  (October) 3 , [Epub ahead of print]
    PubMedGoogle Scholar
  • 87 Hudson D A, Dent D M, Lazarus D. One-stage immediate breast and nipple-areolar reconstruction with autologous tissue I: a preliminary report.  Ann Plast Surg. 2000;  45(5) 471-476
    CrossrefPubMedGoogle Scholar
  • 88 Colen L B. One-stage reconstruction of the breast using autologous tissue with immediate nipple reconstruction. In: Spear SL, Little JW, Lippman ME, Wood WC Surgery of the Breast: Principles are Art. Philadelphia, PA; Lippincott-Raven 1998: 491-510
    PubMedGoogle Scholar
  • 89 Delay E, Mojallal A, Vasseur C, Delaporte T. Immediate nipple reconstruction during immediate autologous latissimus breast reconstruction.  Plast Reconstr Surg. 2006;  118(6) 1303-1312
    CrossrefPubMedGoogle Scholar
  • 90 Williams E H, Rosenberg L Z, Kolm P, de la Torre J I, Fix R J. Immediate nipple reconstruction on a free TRAM flap breast reconstruction.  Plast Reconstr Surg. 2007;  120(5) 1115-1124
    CrossrefPubMedGoogle Scholar
  • 91 Thomas S V, Gellis M B, Pool R. Nipple reconstruction with a new local tissue flap.  Plast Reconstr Surg. 1996;  97(5) 1053-1056
    CrossrefPubMedGoogle Scholar
  • 92 Nakajima T, Yoshimura Y, Kami T. The subcutaneous pedicle flap: widening of its applications.  Ann Plast Surg. 1987;  19(2) 103-116
    CrossrefPubMedGoogle Scholar
  • 93 Hyakusoku H, Okubo M, Fumiiri M. Combination of the square flap method and the dermal sling to correct flat or inverted nipples.  Aesthetic Plast Surg. 1988;  12(2) 107-109
    CrossrefPubMedGoogle Scholar
  • 94 Kurihara K, Maezawa N, Yanagawa H, Imai T. Surgical correction of the inverted nipple with a tendon graft: hammock procedure.  Plast Reconstr Surg. 1990;  86(5) 999-1003
    CrossrefPubMedGoogle Scholar
  • 95 Yamamoto Y, Sugihara T. Correction of inverted nipple with modified star flap technique.  Aesthetic Plast Surg. 1997;  21(3) 193-195
    CrossrefPubMedGoogle Scholar
  • 96 Pribaz J J, Pousti T. Correction of recurrent nipple inversion with cartilage graft.  Ann Plast Surg. 1998;  40(1) 14-17
    CrossrefPubMedGoogle Scholar
  • 97 Sakai S, Sakai Y, Izawa H. A new surgical procedure for the very severe inverted nipple.  Aesthetic Plast Surg. 1999;  23(2) 139-143
    CrossrefPubMedGoogle Scholar
  • 98 Pereira Filho O J, Bins-Ely J, Granemann A S, Bertelli J A, Abdalla S C. Closed inverted nipple treatment through a microincision procedure.  Plast Reconstr Surg. 2001;  108(4) 1000-1005
    CrossrefPubMedGoogle Scholar
  • 99 Scholten E. A contemporary correction of inverted nipples.  Plast Reconstr Surg. 2001;  107(2) 511-513
    CrossrefPubMedGoogle Scholar
  • 100 Huang W C. A new method for correction of inverted nipple with three periductal dermofibrous flaps.  Aesthetic Plast Surg. 2003;  27(4) 301-304
    CrossrefPubMedGoogle Scholar
  • 101 Lee M J, Depoli P A, Casas L A. Aesthetic and predictable correction of the inverted nipple.  Aesthet Surg J. 2003;  23(5) 353-356
    CrossrefPubMedGoogle Scholar
  • 102 Kim D Y, Jeong E C, Eo S R, Kim K S, Lee S Y, Cho B H. Correction of inverted nipple: an alternative method using two triangular areolar dermal flaps.  Ann Plast Surg. 2003;  51(6) 636-640
    CrossrefPubMedGoogle Scholar
  • 103 Stevens W G, Fellows D R, Vath S D, Stoker D A. An integrated approach to the repair of inverted nipples.  Aesthet Surg J. 2004;  24(3) 211-215
    CrossrefPubMedGoogle Scholar
  • 104 Yamada N, Kakibuchi M, Kitayoshi H, Kurokawa M, Hosokawa K, Hashimoto K. A method for correcting an inverted nipple with an artificial dermis.  Aesthetic Plast Surg. 2004;  28(4) 233-238
    PubMedGoogle Scholar
  • 105 Kim J T, Lim Y S, Oh J G. Correction of inverted nipples with twisting and locking principles.  Plast Reconstr Surg. 2006;  118(7) 1526-1531
    CrossrefPubMedGoogle Scholar
  • 106 Burm J S, Kim Y W. Correction of inverted nipples by strong suspension with areola-based dermal flaps.  Plast Reconstr Surg. 2007;  120(6) 1483-1486
    CrossrefPubMedGoogle Scholar
  • 107 Bosch G, de los Ríos G, Giachero V. Nipple invagination: the umbrella effect.  Aesthetic Plast Surg. 2007;  31(1) 76-84
    CrossrefPubMedGoogle Scholar
  • 108 Wu H L, Huang X, Zheng S S. A new procedure for correction of severe inverted nipple with two triangular areolar dermofibrous flaps.  Aesthetic Plast Surg. 2008;  32(4) 641-644
    CrossrefPubMedGoogle Scholar
  • 109 Karacaoglu E. Correction of recurrent grade III inverted nipple with antenna dermoadipose flap: case report.  Aesthetic Plast Surg. 2009;  (March) 19 , (Epub ahead of print)
    PubMedGoogle Scholar
  • 110 Marshall K A, Wolfort F G, Cochran T C. Surgical correction of nipple hypertrophy in male gynecomastia: case report.  Plast Reconstr Surg. 1977;  60(2) 277-279
    CrossrefPubMedGoogle Scholar
  • 111 Skillman J M, Ahmed O, Dheansa B, Rowsell A R. The Marshall technique: an economic one-stage technique for nipple-areola reconstruction.  Br J Plast Surg. 2002;  55(6) 504-506
    CrossrefPubMedGoogle Scholar
  • 112 Nohira K, Shintomi Y, Ohura T. Nipple-areola reconstruction using a skate flap and an intradermal tattoo.  Jpn J Plast Reconstr Surg. 1991;  34 67-72
    PubMedGoogle Scholar
  • 113 Eskenazi L. A one-stage nipple reconstruction with the “modified star” flap and immediate tattoo: a review of 100 cases.  Plast Reconstr Surg. 1993;  92(4) 671-680
    CrossrefPubMedGoogle Scholar
  • 114 Zhong T, Antony A, Cordeiro P. Surgical outcomes and nipple projection using the modified skate flap for nipple-areolar reconstruction in a series of 422 implant reconstructions.  Ann Plast Surg. 2009;  62(5) 591-595
    CrossrefPubMedGoogle Scholar
  • 115 Hallock G G. Polyurethane nipple prosthesis.  Ann Plast Surg. 1990;  24(1) 80-85
    CrossrefPubMedGoogle Scholar
  • 116 Tanabe H Y, Tai Y, Kiyokawa K, Yamauchi T. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage.  Plast Reconstr Surg. 1997;  100(2) 431-438
    CrossrefPubMedGoogle Scholar
  • 117 Bernard R W, Beran S J. Autologous fat graft in nipple reconstruction.  Plast Reconstr Surg. 2003;  112(4) 964-968
    CrossrefPubMedGoogle Scholar
  • 118 Cheng M H, Ho-Asjoe M, Wei F C, Chuang D C. Nipple reconstruction in Asian females using banked cartilage graft and modified top hat flap.  Br J Plast Surg. 2003;  56(7) 692-694
    CrossrefPubMedGoogle Scholar
  • 119 Nahabedian M Y. Secondary nipple reconstruction using local flaps and AlloDerm.  Plast Reconstr Surg. 2005;  115(7) 2056-2061
    CrossrefPubMedGoogle Scholar
  • 120 Cheng M H, Rodriguez E D, Smartt J M, Cardenas-Mejia A. Nipple reconstruction using the modified top hat flap with banked costal cartilage graft: long-term follow-up in 58 patients.  Ann Plast Surg. 2007;  59(6) 621-628
    CrossrefPubMedGoogle Scholar
  • 121 Lipa J E, Addison P D, Neligan P C. Patient satisfaction following nipple reconstruction incorporating autologous costal cartilage.  Can J Plast Surg. 2008;  16(2) 85-88
    PubMedGoogle Scholar

Warren RozenM.B.B.S. B.Med.Sc. P.G.Dip.Surg.Anat. Ph.D. 

Jack Brockhoff Reconstructive Plastic Surgery Research Unit

Room E533, Department of Anatomy, University of Melbourne, Grattan St, Parkville, 3050 Victoria, Australia

Email: warrenrozen@hotmail.com

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