Abstract: "The Lightning Bolt Flap:" A Novel C-V Flap Modification for Nipple Reconstruction.
Nipple reconstruction following total mastectomy with breast reconstruction is often a crucial final step in restoring natural breast aesthetics and improving patient self-image. Among available techniques, the C-V flap is widely utilized due to its technical simplicity, reliability, and high patient satisfaction rates. However, lasting nipple projection is limited by its reliance on subcutaneous fat to fill dead space beneath the elevated flaps. To address this limitation, implants - such as synthetic or biologic cylindrical grafts - have demonstrated long-term maintenance of cosmetic outcomes. Despite improved nipple projection, inserts are associated with a higher risk of complications, including graft extrusion or exposure, necrosis, and wound dehiscence. Furthermore, some patients may desire optimal cosmesis while declining implants for financial considerations or personal preference. In this technical report, we describe a novel modification of the C-V flap that uses de-epithelialized, vascularized dermal V flaps to provide internal structural support and maintain nipple projection following implant-based breast reconstruction after total mastectomy.