title: Nipple reconstruction using a star flap enhanced by scar tissue: the Regina Elena Cancer Institute experience.
abstract: BACKGROUND
  We propose a new, simple, and reliable method of nipple reconstruction using a star flap and a free graft of a linear fragment of scar tissue. The harvested fragment is deepithelialized and fixed under the flap to give the reconstruction consistency and make it steady.
  
  
  METHODS
  The study included 218 nipple reconstructions performed between 2002 and 2008. In an attempt to estimate their satisfaction, patients were then asked to complete a 1-year postoperative questionnaire. Patients were directed to use a numerical scale of 1-10, with 1 as the worst outcome and 10 as the best possible outcome.
  
  
  RESULTS
  The average projection of the nipple in the immediate postoperative period was 7.08 ± 0.5 mm (mean ± standard deviation). After 1 year, the average projection of the reconstructed nipple was 6.08 ± 0.5 mm. The average diameter of the reconstructed nipple in the immediate postoperative period was 14.9 ± 3 mm. After 1 year, the average diameter of the reconstructed nipple was 14.2 ± 4 mm. The average patient satisfaction with nipple projection was 7.28, sensation of the nipple, 4.11; color of the nipple, 6.36; position of the reconstructed nipple, 7.34; and symmetry compared with the opposite nipple-areola complex, 7.97. Overall patient satisfaction was 6.61.
  
  
  CONCLUSIONS
  We maintain that the technique presented here is safe, easy to perform, and reproducible and improves the long-term projection of the reconstructed nipple.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Regina Elena Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Gullo
authors.forename: Ernesto Maria
authors.initials: EM
authors.lastname: Buccheri
authors.forename: Marcello
authors.initials: M
authors.lastname: Pozzi
authors.forename: Roy
authors.initials: R
authors.lastname: De Vita
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D002921:Cicatrix / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D007558:Italy; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D020858:Tissue and Organ Harvesting / Q000379:methods; D014945:Wound Healing / Q000502:physiology