Case 17 2026: Papilla Reconstruction Using the Tennessee Flap Following DIEP Flap Breast Reconstruction

Keywords: Tennessee flap, modified C-H flap, nipple reconstruction, invasive ductal carcinoma, DIEP flap, secondary breast reconstruction Authors: Mikkel Halborg Sørensen, MD; Nanja Gotland Sundstrup, MD; Christian Lyngsaa Lang, MD Institution: Department of Plastic Surgery and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark Abstract A 50-year-old woman with a history of invasive ductal carcinoma (IDC) underwent right-sided papilla reconstruction following secondary deep inferior epigastric perforator (DIEP) flap breast reconstruction. A Tennessee flap technique was used in conjunction with correction of lateral volume of the DIEP flap. The technique provided projection and predictable positioning relative to the contralateral nipple-areola complex. The procedure was performed under local anesthesia in an outpatient setting. The immediate postoperative appearance was satisfactory, and wound healing proceeded without complications. This case higlights the continued utility of the Tennessee flap as a simple, safe, and reproducible technique for delayed nipple reconstruction. Patient medical history A 50-year-old woman with a history of IDC underwent right-sided subcutaneous mastectomy in 2017. In 2025, she underwent unilateral delayed autologous breast reconstruction using a DIEP flap. In 2026, completion of the reconstructive process was planned with papilla reconstruction. The patient was in good general health, non-smoking, and without known comorbidities. Before and After Patient examination Clinical examination demonstrated a well-integrated right-sided DIEP flap, good symmetry compared to the contralateral breast, even though the flap was too voluminous at the lateral side. Absence of nipple-areola complex (NAC) on the reconstructed side and a contralateral areola with soft and not sharply demarcated borders. A well-healed lower abdominal donor-site scar from the DIEP flap harvest was present. Pre-operative considerations In Denmark, the Tennessee