C-Y Trilobe Nipple Reconstruction
A series of figures illustrating the surgical technique for C-Y Trilobe Nipple Reconstruction. Created for Dr. David Song, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital. Submitted to Annals of Plastic Surgery for publication in January 2023.
Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. (A) The design is similar to C-V flaps but with square lateral extensions. Patient should be marked with lateral extensions measuring 1 cm x 1 cm and 3 cm in entirety.
(B) The initial incision and elevation were performed with a 15-blade. The lateral flaps are elevated with approximately 1 millimeter of fat on the dermis. When the central mound is reached, thickness is taken to about 5 millimeters of fat to provide adequate bulk; when complete, the flap should be able to stand up by itself.
(C) The two corners are then approximated with deep dermal sutures. Next, the lateral triangular stitch should be placed to create the Y component in the flat. The triangular stitch should gather on all three sides of the donor site, making a Y. This is repeated on the opposite side.
(D) Following donor site closure, the remaining flaps are tacked together with deep dermal sutures. Initially, bringing together the lateral flaps and then securing them to the base. Lastly, a stitch securing the top flap fastening to the lateral flaps. The remaining incisions are closed with a running 5-0 Caprosyn.
(E) The donor scar length is short, and the nipple will have good projection. Tattooing of this nipple-areolar complex can occur postoperatively.