Original ArticleNipple Reconstruction Using the Modified Top Hat Flap With Banked Costal Cartilage Graft Long-Term Follow-up in 58 PatientsCheng, Ming-Huei MD, MHA*‡; Rodriguez, Eduardo D. MD, DDS†; Smartt, James M. MD*; Cardenas-Mejia, Alexander MD*Author Information From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan; the †Department of Plastic and Reconstructive Surgery, The R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD; and ‡Xiamen Chang Gung Hospital. Reprints: Ming-Huei Cheng, MD, MHA, Associate Professor and Chief, Division of Microsurgery and Hand, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kwei-Shan, Tao-Yuan, 333 Taiwan. E-mail: [email protected]. Annals of Plastic Surgery: December 2007 - Volume 59 - Issue 6 - p 621-628 doi: 10.1097/SAP.0b013e318048573c Buy Metrics AbstractIn Brief The long-term projection of nipple reconstruction is a challenge. Fifty-eight consecutive female patients underwent 58 nipple reconstructions with modified top hat flap with cartilage graft following breast reconstruction in 54 autologous tissues and 4 implants, respectively. The average neonipple size was 11.5 mm initially and 8.5 mm at a mean follow-up of 44.9 months (range, 24–65 months), with a mean decrease in projection of 26.1%. Thirty-three patients achieved an excellent result, 20 patients a good result, 3 patients a fair result, and 2 patients a poor result, respectively. The complication rate was 12.1% (7 of 58 cases), and there was no statistically significant difference between the immediate and delayed groups; the revision rate was 8.6% (5 of 58 cases). The modified top hat flap with banked costal cartilage graft provides a sustainable solution to the gradual loss of nipple projection, with few complications. Fifty-eight consecutive modified top-hat nipple reconstructions with a centrally bolstering cartilage graft showed a mean projection loss of 26.1% over a mean follow-up of 45 months. The complication rate was 12.1% and the revision rate 8.6%. © 2007 Lippincott Williams & Wilkins, Inc.