Nipple-Areolar Complex Reconstruction

A Review of the Literature and Introduction of the Rectangle-to-Cube Nipple Flap

Joshua T. Henderson, BA; Thomas J. Lee, MD; Andrew M. Swiergosz, BS; Andrea R. Hiller, BS; Joshua Choo, MD; Bradon J. Wilhelmi, MD, FACS


ePlasty. 2018;18(e15) 

In This Article

Abstract and Introduction


Objective: There are many approaches to nipple-areola complex reconstruction. Tissue quality and thickness, desired nipple location and size, scar position, and surgeon preference all play a role in selecting a technique. We present the rectangle-to-cube nipple flap, a new technique for challenging nipple reconstruction. A review of published techniques is compared and contrasted with this flap design.

Methods: Following bilateral total skin-sparing mastectomies, a patient with breast cancer underwent breast reconstruction with tissue expanders and subsequent nipple reconstruction with the rectangle-to-cube nipple flap. An inferiorly based rectangular flap with medial and lateral extensions is designed inferior to the transverse scar. Upon elevation and rotation, the medial and lateral flaps form a cube.

Results: In all cases of rectangle-to-cube nipple flaps performed at our institution, adequate nipple projection and patient satisfaction have been achieved at 2-month postoperative evaluation.

Conclusion: The rectangle-to-cube nipple flap provides sustained nipple projection due to the de-epithelialized base on which the flap sits. The rectangle-to-cube nipple flap also takes advantage of a long transverse scar, and it can be extended to include longer scars for scar revisions.


Nipple-areolar complex reconstruction (NAR), the final stage in breast reconstruction, encompasses numerous surgical techniques. The advantages of each method must be considered to ensure adequate nipple projection and optimal aesthetic result. The rectangle-to-cube nipple flap is a new technique that offers persistent protrusion with the unique advantage of utilization of a long transverse scar.