CC BY-NC 4.0 · Arch Plast Surg 2019; 46(02): 129-134
DOI: 10.5999/aps.2018.00164
Original Article

The oval technique for nipple-areolar complex reconstruction

Department of Plastic, Reconstructive and Aesthetic Surgery, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
Department of Plastic, Reconstructive and Aesthetic Surgery, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
Department of Plastic, Reconstructive and Aesthetic Surgery, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
Department of Plastic, Reconstructive and Aesthetic Surgery, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
Unit of Plastic, Reconstructive and Aesthetic Surgery, University of Naples Federico II, Naples, Italy
› Institutsangaben

Background Nipple-areolar complex (NAC) reconstruction is the final stage of breast reconstruction. Ideal reconstruction of the NAC requires symmetry in position, size, shape, texture, pigmentation, and permanent projection, and although many technical descriptions of NAC reconstruction exist in the medical literature, there is no gold standard technique. The technique devised by the authors is very versatile, with excellent results, and it enables 1-step reconstruction with optimal results in terms of shape and nipple projection.

Methods Our technique consists of a combination of modified local flaps and a full-thickness skin graft. Patients were observed for 18 months to estimate the amount of retraction. This procedure was performed in 40 patients, four of them bilaterally. The duration of the follow-up was 30 months. Complications occurred in 10% of patients, and included infections (5%), ischemia (2.5%), and hematoma (2.5%).

Results No cases of total nipple necrosis were reported. The NAC shape remained optimal in all cases, with a very small reduction of the vertical and horizontal diameters of the areola, which maintained its designed round shape well, and negligible retraction in the diameter and projection of the nipple.

Conclusions The oval technique represents a major step forward, involving a combination of existing techniques, such as the C-V flap and the cutaneous graft, to achieve excellent results regarding areola shape and nipple projection, significantly reducing the cases of nipple ischemia. These results were substantially obtained through subcutaneous equatorial sutures, skin grafting, and flattening of the apexes of the flap.


Eingereicht: 20. Februar 2018

Angenommen: 12. September 2018

Artikel online veröffentlicht:
03. April 2022

© 2019. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA


  • 1 Alderman AK, Wilkins EG, Lowery JC. et al. Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 2000; 106: 769-76
  • 2 Wilkins EG, Cederna PS, Lowery JC. et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2000; 106: 1014-25
  • 3 Adams WM. Labial transplant for correction of loss of the nipple. Plast Reconstr Surg (1946) 1949; 4: 295-8
  • 4 Gruber RP. Nipple-areola reconstruction: a review of techniques. Clin Plast Surg 1979; 6: 71-83
  • 5 Millard Jr DR. Nipple and areola reconstruction by split-skin graft from the normal side. Plast Reconstr Surg 1972; 50: 350-3
  • 6 Brent B, Bostwick J. Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg 1977; 60: 353-61
  • 7 Broadbent TR, Woolf RM, Metz PS. Restoring the mammary areola by a skin graft from the upper inner thigh. Br J Plast Surg 1977; 30: 220-2
  • 8 Klatsky SA, Manson PN. Toe pulp free grafts in nipple reconstruction. Plast Reconstr Surg 1981; 68: 245-8
  • 9 Hallock GG, Altobelli JA. Cylindrical nipple reconstruction using an H flap. Ann Plast Surg 1993; 30: 23-6
  • 10 Little 3rd JW, Munasifi T, McCulloch DT. One-stage reconstruction of a projecting nipple: the quadrapod flap. Plast Reconstr Surg 1983; 71: 126-33
  • 11 Rubino C, Dessy LA, Posadinu A. A modified technique for nipple reconstruction: the ‘arrow flap’. Br J Plast Surg 2003; 56: 247-51
  • 12 Bhatty MA, Berry RB. Nipple-areola reconstruction by tattooing and nipple sharing. Br J Plast Surg 1997; 50: 331-4
  • 13 Few JW, Marcus JR, Casas LA. et al. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg 1999; 104: 1321-4
  • 14 Shestak KC, Gabriel A, Landecker A. et al. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg 2002; 110: 780-6
  • 15 Sisti A, Grimaldi L, Tassinari J. et al. Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol 2016; 42: 441-65
  • 16 Borsen-Koch M, Bille C, Thomsen JB. Promising results after single-stage reconstruction of the nipple and areola complex. Dan Med J 2013; 60: A4674
  • 17 Lelli JL, Rapp DA, Komorowska-Timek E. Temporary areolar demarcation for nipple-areola complex reconstruction. Plast Reconstr Surg Glob Open 2015; 3: e490