I was interested to see the convergent evolution of nipple reconstruction between my practice and the article by Shestak and Nguyen.1 A few technical improvements I learned to maximize results are as follows:
- Start with an oval areolar marking (not a circle), with the long axis of the oval perpendicular to the axis of the lateral flaps. This will result in a circular final areola (if this is desired, as compared with the normal side).
- The central axis of the lateral flaps should be at the 3 and 9 o’clock positions, to allow the remaining semicircular regions of the areola to be symmetrical and thus the nipple to be in the center of the areola.
- Include as much fat as possible in the flaps, to improve the bulk of the final nipple. Include the underlying muscle and capsule if the reconstruction is over an implant.
- The areolar margin incisions do not have to be circumferential, but they should be long enough to allow redistribution of the skin surrounding the new areola. I have also found that a purse-string suture is not necessary for closure.
My results with these modifications have been gratifying over the past number of years (Fig. 1).
Michael J. Halls, M.D.
Alvarado Institute of Plastic and Reconstructive Surgery
6386 Alvarado Court, Suite 330
San Diego, Calif. 92120
1. Shestak, K. C., and Nguyen, T. D. The double-opposing periareolar flap: A novel concept for nipple-areola reconstruction. Plast. Reconstr. Surg.
119: 473, 2007.
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.
Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/.
We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.