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Purse-String Nipple Areolar Reconstruction

Weinfeld, Adam Bryce MD*; Somia, Naveen MD; Codner, Mark A. MD

doi: 10.1097/SAP.0b013e31815d898a
Breast Surgery

We present a surgical technique of nipple areolar reconstruction that uses a purse-string to increase areolar projection while reducing loss of nipple projection. A permanent purse-string is used around a modified CV flap to advance tissue centrally to the base of the nipple reconstruction. Two opposing hemiareolar island flaps are advanced toward the base of the nipple to add tissue volume. The resulting circumareolar full thickness skin is closed using a permanent purse-string suture. Synching the purse-string suture produces an effect similar to that of a periareolar mastopexy and enhances areolar projection. Eighty-two patients underwent 108 nipple areola reconstructions. Ninety-six percent of the patients achieved good results without any flap loss or suture infections. Revision surgery was necessary in 4 patients for minor problems including asymmetry or loss of projection. The purse-string nipple areolar reconstruction method described results in a high rate of maintenance of projection and patient satisfaction.

From the *University Medical Center at Brackenridge, and Dell Children’s Medical Center of Central Texas, Austin, TX; and †Paces Plastic Surgery, Atlanta, GA.

Received June 5, 2007 and accepted for publication, after revision, October 9, 2007.

Presented at the Atlanta Breast Symposium, Atlanta, GA, January 2000, 2001, and 2007.

The authors do not have any commercial associations or financial relationships that might pose or create a conflict of interest with information presented in this manuscript.

Reprints: Mark A. Codner, MD, Paces Plastic Surgery, 3200 Downwood Circle, Suite 640, Atlanta, GA 30327. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.