title: Nipple reconstruction with combination of modified CV flap and contralateral nipple composite graft.
abstract: BACKGROUND
  Numerous nipple reconstruction methods have been proposed including the use of local flaps and composite grafts, but most methods have shown a significant loss of projection. We combined a modified CV flap with a composite graft (nipple sharing) to maximize the projection and volume of the new nipple and reduce the size of the contralateral nipple.
  
  
  METHODS
  In total, 30 patients underwent nipple reconstruction using a combined method between January 2013 and November 2015. This technique was selected if the diameter of the contralateral nipple was large and the thickness of the skin was less than 2 mm. After the modified CV flap was created, a composite graft from the contralateral nipple was placed between the V flaps and the C flap. The loss of projection and the ratio of the new nipple to the contralateral nipple were evaluated 12 months after surgery.
  
  
  RESULTS
  Nipple reconstruction was successful in all cases. The projection at 12 months after reconstruction was 68% of the initial projection, and the mean projection ratio of the new nipple to the contralateral nipple was 0.81. There was no complication in the donor nipple; in fact, the shape was improved with nipple reduction, and the scar was inconspicuous.
  
  
  CONCLUSIONS
  Nipple reconstruction that combines a modified CV flap and composite graft can maximize the nipple projection and provide a chance for nipple symmetry as the two components will act synergistically.
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea.
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Inje University Busan Paik Hospital, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yun
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea.
authors.forename: Hyung Chul
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea.
authors.forename: Ji Hong
authors.initials: JH
authors.lastname: Yim
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea. Electronic address: jinsupp@amc.seoul.kr.
authors.forename: Jin Sup
authors.initials: JS
authors.lastname: Eom
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps
keywords: Composite graft; Flap; Nipple reconstruction