Case 12: Flower Flap - A Novel Papilla Reconstruction Technique Using Local Flaps and Skin Graft

Keywords: Flower Flap, Papilla reconstruction, nipple reconstruction, breast revision, full-thickness skin graft, dog ear correction Authors: Anna Louise Norling, MD, Nanja Gotland Sundstrup, MD, Matilda Svenning Hunt, MD and Pia Cajsa Leth Andersen, MD. Institution: Department of Plastic Surgery and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark Abstract A 47-year-old woman underwent bilateral papillae reconstruction using a novel reconstruction technique involving four local flaps and a full-thickness skin graft including subcutaneous tissue from excised dog ears, due to scar correction, following a DIEP flap breast reconstruction. This technique preserved breast projection, avoided additional scarring, and improved breast contour. Initial epidermolysis occurred, as expected with a thick graft, but the grafts survived. At one month follow-up, the papillae showed resolving discoloration. This simple and reliable method facilitates simultaneous nipple reconstruction and aesthetic breast contouring with minimal donor-site morbidity. Patient medical history A 47-year-old woman with a history of DCIS in the left breast and a family history of breast cancer (BRCA-negative) initially underwent bilateral subcutaneous mastectomy with NAC removal and implant-based reconstruction in 2021. Due to dissatisfaction with the result, she had bilateral DIEP flap reconstruction in May 2023. In July 2024, a revision was performed to improve the breast shape, including correction of dog ears and redundant skin on the DIEP flaps, as well as lateral liposuction. At the 3-month follow-up, the breasts remained laterally full with a square appearance. A new revision was planned to refine the contour and simultaneously reconstruct the nipple using a novel technique combining four small local flaps and a full-thickness skin graft with subcutaneous tissue. Before and After Patient examination The patient was a well-preserved woman with good-quality skin. Clinical examination r