Institutional members access full text with Ovid®

Share this article on:

Repairing the High-Riding Nipple with Reciprocal Transposition Flaps

Spear, Scott L. M.D.; Albino, Frank P. M.D.; Al-Attar, Ali M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 687–689
doi: 10.1097/PRS.0b013e3182818a24
Breast: Ideas and Innovations

Summary: The high-riding nipple-areola complex is a clinical problem that can be encountered following cosmetic and reconstructive breast surgery. Because of the desire to avoid scars on the superior aspect of the breast and the limited availability of superior breast skin, it can be technically challenging to place the nipple-areola complex in a lower position. Multiple surgical strategies have attempted to lower it, and each has its advantages and disadvantages. Reciprocal rotation flaps have been used by the authors with success. They describe the surgical technique and outcomes in five breasts. The medical records of all patients who had reciprocal rotation flaps for high-riding nipple-areola complexes performed by the senior author (S.L.S.) were reviewed. The institutional review board–approved review included preoperative history and examination, surgical findings, surgical technique, and postoperative course. Five reciprocal rotation flap procedures were performed on four patients between 2005 and 2012 for high-riding nipple-areola complexes. The high-riding nipple-areola complexes were all iatrogenic, following reconstruction for nipple-sparing mastectomy or mastopexy. All nipple-areola complexes were successfully lowered with an average follow-up duration of 2.1 years. One breast that had undergone previous radiation therapy had a nipple-areola complex flap that appeared ischemic; the patient underwent hyperbaric oxygen therapy and the flap fully survived. Reciprocal rotation flaps are an effective strategy for management of the high-riding nipple-areola complex and can be safely performed with thoughtful planning and careful surgical technique. This technique is riskier in the irradiated breast but may be facilitated with hyperbaric oxygen therapy.


Washington, D.C.

From the Department of Plastic Surgery, Georgetown University Hospital.

Received for publication August 12, 2012; accepted October 15, 2012.

Disclosure: Dr. Spear is a consultant to LifeCell Corp. and Allergan, Inc. Neither of the other authors has any disclosures. No external funding supported this study.

Scott L. Spear, M.D.; Department of Plastic Surgery, Georgetown University Hospital, First Floor PHC Building, 3800 Reservoir Road, NW, Washington, D.C. 20007,

©2013American Society of Plastic Surgeons