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Nipple-Areola Reconstruction: Technical Improvements

Halls, Michael J. M.D.

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Plastic and Reconstructive Surgery: January 2008 - Volume 121 - Issue 1 - p 342-343
doi: 10.1097/01.prs.0000294961.44705.0b
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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:

  1. 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).
  2. 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.
  3. 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.
  4. 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).

Fig. 1.
Fig. 1.:
Views of results after nipple-areola reconstruction.

Michael J. Halls, M.D.

Alvarado Institute of Plastic and Reconstructive Surgery

6386 Alvarado Court, Suite 330

San Diego, Calif. 92120

[email protected]


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.

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