Completing the Finishing Touches
Nipple Areola Reconstruction
Post-mastectomy reconstruction can restore the shape, volume, and profile of one or both breasts; however, unless the patient has undergone nipple-sparing mastectomy, the reconstructed breast will be missing the nipple and areola. While some women may be satisfied simply to have the breast itself reconstructed, many desire the more natural appearance that can be provided by the addition of a nipple areola reconstruction. Our plastic surgeons are specialists in breast reconstruction and can choose the method of nipple areola reconstruction that will be most effective at producing the desired results.
The Nipple Areola Reconstruction Procedure
Modern nipple areola reconstruction procedures typically involve creating and using local skin flaps that are elevated directly from skin on the reconstructed breast. In the past, nipple areola reconstruction techniques included taking tissue from the opposite breast and nipple or using skin grafts from the labia or groin. Our surgeons do not favor these older techniques since nipple sharing procedures from the other breast risk moving breast tissue from one side to the other and using labial or groin tissue for a graft may generate hair growth on the new nipple while potentially resulting in undesirable scarring at the donor site.
Today, the type of local skin flap that is used for nipple reconstruction will be decided by your surgeon – examples of the various techniques include the skate flap, C-V flap, and star flap. The local skin flaps elevated are used to create the nipple mound, which produces the contour and texture of the nipple. Once the flaps have been created through small incisions and the nipple mound has been reconstructed, the incisions will be closed and left to heal.
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Over time, as a natural part of the healing process, the nipple will lose some of its projection. If the nipple projection requires correction because it has lost too much elevation, it may be possible to revise the nipple reconstruction through the use of dermal fat grafts, as well as dermal fillers such as Radiesse®. It may also be possible to use an acellular dermal matrix, such as AlloDerm®, at the time of nipple areola reconstruction or at a later date, to help maximize nipple projection. Alternatively, additional secondary skin flap elevation may allow improved nipple contour.
To complete the appearance of the areola, a skin graft can be used or, in most cases, nipple areola tattooing can be done after the nipple reconstruction has healed. If a skin graft is used for the areola, the graft can frequently be taken from the skin adjacent to healed scars elsewhere on the body. For example, in patients who have had a DIEP flap breast reconstruction, a skin graft may be taken from the skin of the lower abdomen where there is already a healed scar. Grafting of the areola is typically done simultaneous with the skin flap nipple reconstruction, although the skin graft can also be done at a second stage. Whether or not a skin graft is used for the areola, a tattooing procedure will complete the reconstruction by providing a more natural color to the nipple and areola. Tattooing of the nipple areola is done as an office procedure once all of the scars have healed.
Risks and Benefits
Nipple areola reconstruction is a safe and simple procedure associated with minimal risk. While great care is taken to maximize healing, occasional problems with wound breakdown are encountered where the local skin flaps are stitched together to create the new nipple. Should this occur, healing is usually achieved with local wound care or, if needed, wound repair in the office. In some cases, in order to potentially decrease the risk of wound problems, a nipple flap delay procedure may be suggested. This involves nipple skin flap elevation and direct closure, typically under local anesthesia, a week or two before the definitive nipple reconstruction surgery. Generally, patients who have a history of prior radiation treatment are more likely to experience complications with healing. Such patients may favor a nipple areola tattooing procedure over a surgical nipple reconstruction. Overall, however, the risks associated with nipple areola reconstruction are few and the potential benefits are great. It is the reconstruction of the nipple and areola that produces the finishing touches that can have a transformative impact on the results of breast reconstruction.
Most patients that undergo post-mastectomy reconstruction are candidates for nipple areola reconstruction. Women with insufficient, thin or radiation damaged breast skin may not be ideal candidates for nipple areola reconstruction. If the skin of the reconstructed breast does not permit a quality nipple reconstruction, tattooing alone can frequently allow the appearance of a natural nipple areola.
Contact the Plastic Surgeons of the
New York Breast Reconstruction Associates at Aesthetic Plastic Surgery, PC
Nipple areola reconstruction can help finalize your breast reconstruction. Please feel free to contact Aesthetic Plastic Surgery, PC today to arrange a consultation with one of our surgeons. We would be happy to guide you through the completion of your breast reconstruction process.