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Just as a successful breast reconstruction cannot be achieved using a solitary method for every patient, no single surgical technique is a panacea for the final stage of nipple creation. For breast mounds with a thin subcutaneous layer, as commonly associated with the implanted breast, local flaps using a central subcutaneous core have strong advocates. The H-shaped local flap introduced here is a variant of the latter where large, well-vascularized side tabs provide adequate projection with minimal risk for flap slough. More importantly, a cylindrical shape geometrically identical to the norm avoids the bulbous appearance frequently resulting from many of the other central-core flap designs.