Integrated breast mound reduction and nipple reconstruction with the wraparound flap

A new method for nipple reconstruction is described that combines revision of an autologous tissue breast mound with creation of a projecting nipple. The method is applicable only to reconstructed breast mounds that must be r educed or lifted to achieve symmetry with the opposite breast. In this tech nique, the mound is reduced as if it were a normal breast, using an inverte d-Tr or vertical mammaplasty pattern. In this way, breast projection can be increased and, if necessary, the inframammary fold can be elevated. A rect angular flap is created from skin and subcutaneous tissue that would normal ly be discarded during the breast reduction, and this flap is wrapped aroun d on itself to form a projecting nipple. This new technique avoids the flattening of the breast mound usually seen a fter nipple reconstruction because it does not take tissue away from the co mpleted breast mound to make the nipple. In appropriate patients who requir e reduction in size of their reconstructed breast mound, the wraparound fla p nipple reconstruction is worth considering.