Nipple reconstruction: The top hat technique

A new surgical technique was evaluated in 23 nipple-areola complex reconstructions in 18 consecutive patients who underwent breast reconstruction techniques. The author used 2 rows of pursestring sutures, one at the base of the neonipple and the other at the periphery of the neoareola. The pursestring sutures act as a supporting platform. The nipple projection was created by suturing in a vertical fashion: 4 horizontal incisions creating 4 supporting pillars. The Montgomery tubercles were simulated by secondary healing of 2- or 3-mm randomly placed stab incisions in the neoareola. The micropigmentation of the nipple-areola complex was performed preferably 6 weeks before the nipple-areola reconstructions. The mean follow-up time was 18 months. The average nipple projection was 6 mm, and the average diameter was 10 mm. Two patients presented with partial loss of nipple projection. Overall, more than 90% of the patients were satisfied with this procedure.