Objective To introduce a special technique for immediate nipple reconstruction， namely intercostal perforator

flap nipple reconstruction. Methods Three typical cases were presented. Among them， two patients underwent stage I breast cancer prosthesis reconstruction. Pathology indicated that there were residual cancer cells in the nipples， and thus nipple reconstruction was carried out. Another patient had undergone right breast cancer reconstruction surgery （prosthesis implantation） for many years， and a new Paget's disease emerged in the right nipple， requiring another surgical treatment. Immediate nipple reconstruction was performed using intercostal artery perforating branch （ICAP） flaps in all cases. Specific procedures： The incision of the inframammary fold was selected， ICAP flap with sufficient width and length was separated， and the blood supply was detected by indocyanine green. According to the scope of fluorescence display， the ischemic part was removed. The C-V nipple reconstruction technique was used to rebuild a nipple with intercostal perforator. The periareolar incision was shrunken by purse-string suture. The reconstructed nipple was put to the shrunken peri-areolar incision， and the lower thoracic advancement flap facilitated the creation of the neo-inframammary fold at last. Results According to

the evaluation of breast surface beautiful score （BSBs） and Breast-Q， all patients were satisfied with the results. After half a year follow-up， the reconstructed nipples survived well. Conclusion The ICAP fl ap is a good technique for immediate nipple reconstruction. The advantage of this technology lies in the fact that this flap has reliable blood supply， suitable volume， and covert scar. Appropriate patient selection， reasonable surgical design and meticulous intraoperative and postoperative care are the key points of this technique.

Nipple reconstruction, Intercostal artery perforator flap, Breast cancer