title: Nipple Reconstruction Using the C-V Flap Technique: Long-Term Outcomes and Patient Satisfaction.
abstract: BACKGROUND
  Nipple creation using the C-V flap technique is often the final step in breast reconstruction. The aim of this study was to subjectively and objectively assess the cosmetic outcomes and satisfaction of patients undergoing C-V flap nipple reconstruction.
  
  
  METHODS
  Subjective assessments of patient satisfaction with the neo-nipple were recorded by visual analogue scoring (VAS; 0-10). Objective measurements were performed using a calliper to measure nipple projection relative to the native breast. Descriptive data analysis was performed with differences in projection assessed with the Mann-Whitney test and mean and median VAS scores (with inter-quartile ranges; IQR) calculated to describe satisfaction.
  
  
  RESULTS
  Thirty-three C-V flap nipple reconstructions were performed. 87.9% received latissimus dorsi (LD) reconstructions with implants and 12.1% had transverse rectus abdominis muscle (TRAM) reconstructions. The median projection of reconstructed nipples was 4.7 mm (range 4-10.2 mm) at 4.6 years mean follow-up, which was not significantly different from the contralateral nipple (p = 0.34). Patient satisfaction was 9 (IQR: 8-10) with shape, 9 (IQR: 7.5-10) with projection, 5 (IQR: 2-9.6) with sensation, and 8.5 (IQR: 6-9.5) with symmetry. Median overall satisfaction was 9 (IQR: 8-10). Three patients had complete nipple loss, of whom two had undergone nipple piercing post procedure and none had received radiotherapy.
  
  
  CONCLUSIONS
  C-V flap nipple reconstructions provide a simple and reliable method to reconstruct the nipple that enhances confidence and perception of body image. Satisfaction was high with long-term outcomes in terms of projection equivalent to the contralateral breast.
authors.affiliation: North Tees and Hartlepool University Hospital NHS Foundation Trust, United Kingdom.
authors.forename: Lona
authors.initials: L
authors.lastname: Jalini
authors.affiliation: North Tees and Hartlepool University Hospital NHS Foundation Trust, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lund
authors.affiliation: Breast and Endocrine Surgeon, North Tees and Hartlepool University Hospital NHS Foundation Trust, United Kingdom.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kurup
keywords: C-V flap; Nipple reconstruction; Patient satisfaction