LAUSR

Achieving nipple reconstruction that maintains projection over the long term can be challenging for the reconstructive breast surgeon. In the Taiwanese patient population, the normal breast usually has a well-projected nipple on a small areolar footprint; therefore, maintenance of nipple projection is a paramount goal in our reconstructive efforts. We have adapted a technique that achieves this goal by utilizing a cartilage graft under the newly created nipple. The modified top hat flap design can be utilized in both implant-based and autologous breast reconstruction patients with suitable aesthetic results and a favorable complication profile. In long-term follow-up, approximately 26% of the initial projection is lost over time, but this can be accounted for by designing the flap with increased projection in mind to achieve a symmetric, pleasing result.