Aesthetic refinements in C-V flap: Raising a perfect cylinder

Nipple reconstruction is the keystone procedure to complete an aesthetically satisfying postmastectomy breast reconstruction. Positioning the nipple at the edge of the breast cone and achieving symmetry with the contralateral side (native or reconstructed nipple) are critical in completing a pleasing result. Furthermore, patient expectations are always higher; aesthetics becomes of paramount concern after having gone through the feelings connected with the disease. In our series, 70% of patients decide to undergo nipple reconstruction, our simple procedure under local anesthesia. It is performed from three to twelve months after autologous or prosthetic breast reconstruction. The C-V flap, one of the most common techniques to reconstruct the nipple, is composed of a central C flap, the distal cap, and two V flaps, the wall of a cylinder, with a horizontal axis.1 During postoperative follow ups, we noticed that the flap folding was not completely natural and tension free, probably due to the triangular V flaps wrapping. The two V flaps, being equal and specular, binding toward each other, do not find the more natural alignment between them and, consequently, with the C flap. Our modifications in drawing a C-V flap to ensure the best folding of a geometrical cylinder is presented.