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. 2016 May 5;4(5):e703.
doi: 10.1097/GOX.0000000000000691. eCollection 2016 May.

Keyhole Flap Nipple Reconstruction

Joseph I Chen  1 , Camille G Cash  1 , Al-Haj Iman  1 , Aldona J Spiegel  1 , Ernest D Cronin  1
Affiliations

Keyhole Flap Nipple Reconstruction

Joseph I Chen et al. Plast Reconstr Surg Glob Open. .

Abstract

Nipple-areola reconstruction is often one of the final but most challenging aspects of breast reconstruction. However, it is an integral and important component of breast reconstruction because it transforms the mound into a breast. We performed 133 nipple-areola reconstructions during a period of 4 years. Of these reconstructions, 76 of 133 nipple-areola complexes were reconstructed using the keyhole flap technique. The tissue used for the keyhole dermoadipose flap technique include transverse rectus abdominus myocutaneous flaps (60/76), latissimus dorsi flaps (15/76), or mastectomy skin flaps after tissue expanders (1/76). The average patient follow-up was 17 months. The design of the flap is based on a keyhole configuration. The base of the flap determines the width of the future nipple, whereas the length of the flap determines the projection. We try to match the projection of the contralateral nipple if present. The keyhole flap is simple to construct yet reliable. It provides good symmetry and projection and avoids the creation of new scars. The areola is then tattooed approximately 3 months after the nipple reconstruction.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the Division of Plastic Surgery, Houston Methodist Hospital.

Figures

Fig. 1.
Fig. 1.
A to A, 1.5 to 2 cm; A to E, 2 to 2.5 cm; E to E, 1.5 to 2 cm. Step 1: The incision of the keyhole is made through the dermis into the subcutaneous fat. Step 2: The flap is elevated distally with a thickness of 5 mm and tapered to 8 mm proximally, thus preserving the blood supply to the flap. Step 3: The flap is folded on itself. Step 4: E to E is sutured at the base of B to B. Points B to B and C to C are sutured together.
Fig. 2.
Fig. 2.
Bilateral transverse rectus abdominus myocutaneous breast reconstruction 15 months after bilateral keyhole nipple reconstruction with circumareolar closure.
Fig. 3.
Fig. 3.
The patient after bilateral mastectomies with bilateral latissimus dorsi flap reconstruction with implants 3 months postoperatively.
Fig. 4.
Fig. 4.
Complication rates of keyhole flap versus all other nipple-areola techniques.
Video Graphic 1.
Video Graphic 1.
See Supplemental Digital Content 1, which demonstrates keyhole flap nipple reconstruction. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A190.
See this image and copyright information in PMC

References

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