# Advancing Nipple Reconstruction in Skin-Sparing Mastectomy: The Efficacy of the Long V-Y Flap Technique for Enhanced Size Retention and Symmetry

## TL;DR

This study evaluates a long V-Y flap technique for nipple reconstruction after skin-sparing mastectomy, showing better retention of size and projection compared to other methods.

## Contribution

The study provides empirical evidence supporting the long V-Y flap as a reliable technique for maintaining nipple volume and projection after skin-sparing mastectomy.

## Key findings

- The long V-Y flap had a mean volume loss of 34.23% and projection loss of 32.79% over six months.
- Nipple width remained largely unchanged over time with the long V-Y flap technique.
- The long V-Y flap showed better outcomes compared to skate, star, bell, and arrow flaps in terms of volume and projection retention.

## Abstract

Reconstruction of the nipple is the final step of breast reconstruction following skin-sparing mastectomy (SSM) and plays a critical role in restoring breast symmetry and aesthetic completeness. Various nipple reconstruction techniques have been described, including split transplantation of normal nipples and flap-based procedures; however, long-term maintenance of nipple projection and volume remains challenging due to postoperative tissue loss. This study evaluates the clinical outcomes of a previously described long V-Y flap technique, focusing on its ability to mitigate postoperative nipple projection and volume loss. A retrospective analysis was performed on 27 patients who underwent nipple reconstruction using the long V-Y flap following SSM with tissue expander–implant reconstruction. Nipple projection and volume were measured immediately after surgery and at follow-up beyond six months, and volume loss rates were calculated. Outcomes were compared descriptively with projection loss rates reported for other commonly used flap techniques in the literature. The mean nipple volume loss was 34.23%, and the mean projection loss was 32.79%, while nipple width remained largely unchanged over time. These values were numerically lower than those reported for skate, star, bell, and arrow flaps in prior studies. The long V-Y flap appears to be a practical and reliable option for nipple reconstruction after SSM, particularly for larger nipples, with favorable short- to mid-term maintenance of projection and volume.