Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 4 2024 01 09 139 142 EN Javad Rahmati Plastic and Reconstructive Surgery Department, Medicine School, Tehran University of Medical Sciences, Tehran, Iran Shahriar Haddady Abianeh Plastic and Reconstructive Surgery Department, Medicine School, Tehran University of Medical Sciences, Tehran, Iran AND Plastic and Reconstructive Surgery Department, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran Hosseinali Abdolrazaghi Hand and Reconstructive Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Iraj Pourahmadian Plastic and Reconstructive Surgery Department, Medicine School, Mazandaran University of Medical Sciences, Sari, Iran Hojjat Molaei Plastic and Reconstructive Surgery Department, Medicine School, Tehran University of Medical Sciences, Tehran, Iran 2023 04 18 2023 09 03 NAC reconstruction represents the final stage of breast reconstruction. This can be  accomplished thr ough non-surgical and surgical procedures, each with its own set of advantages and disadvantages. The majority of surgeons employ the Skate flap. The following is a de monstration of a modific ation to this flap.A woman, 56 years of age, who had previously undergone breast reconstruction using a TRAM flap, was admitted for nipple reconstruction. During the design of the star flap, a modification was executed, which involved reciprocally changing the orientation of the lateral flaps. Both flaps were properly positioned in their prepared locations during the flap inset and skin closure. The final outcome was satisfactory and aesthetically pleasing.The modification in the design of the Skate flap alters the orientation of the transferred flaps, making the final inse t feasible with less dis figurement. https://crcp.tums.ac.ir/index.php/crcp/article/view/813