Nipple Reconstruction Using the C-v Flap Technique: Long-term Outcomes

Introduction: Nipple creation using the C-V flap technique is often the final step in breast reconstruction. The aim of this study was to assess subjectively and objectively the cosmetic outcomes and satisfaction of patients undergoing C-V flap nipple reconstruction. Methods: Subjective assessments of patient satisfaction with the neo-nipple 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 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. Conclusion: C-V flap nipple reconstruction provides a straightforward and reliable method to reconstruct the nipple that enhances confidence and perception of body image. Satisfaction was high with long-term outcomes and in terms of projection equivalent to the contralateral breast.