Background <p>A central mastectomy scar crossing the intended neo-nipple site may complicate nipple reconstruction by limiting flap design and optimal positioning. This study describes a costal cartilage-supported modification of the Delta flap concept for nipple reconstruction after latissimus dorsi flap breast reconstruction.</p> Methods <p>This retrospective single-center study included eight consecutive patients treated between January 2022 and March 2026. All patients had previously undergone latissimus dorsi flap breast reconstruction, and the mastectomy scar crossed the planned neo-nipple site. Paired opposing delta-shaped local flaps were combined with an autologous costal cartilage graft harvested through the previous inframammary fold incision. Neo-nipple projection was measured with a caliper intraoperatively and at 1, 3, and 6 months. Complications, aesthetic outcomes, and patient satisfaction were recorded.</p> Results <p>Mean neo-nipple projection decreased from 13.3 ± 0.8&#xa0;mm intraoperatively to 6.1 ± 0.4&#xa0;mm at 6 months, corresponding to a mean projection loss of 53.9 ± 1.9%. Two patients experienced minor wound-related complications: one partial flap necrosis requiring minor revision and one minor wound dehiscence managed without surgery. No major complication, infection, cartilage extrusion, or donor-site morbidity was observed. At 6 months, the mean aesthetic score assigned by three independent plastic surgeons and the mean patient satisfaction score were both 8.0 ± 0.8 out of 10.</p> Conclusions <p>This costal cartilage-supported modification of the Delta flap represents a feasible scar-oriented option for nipple reconstruction in selected latissimus dorsi flap breasts. Comparative studies with longer follow-up are required to clarify the durability of projection and the role of cartilage support.</p> Level of evidence <p>Level IV, therapeutic study.</p>