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Nipple Areola Reconstruction

Creating the nipple areola is the final component to making your breast reconstruction complete. There have been numerous approaches to nipple reconstruction over the last 30 years, and with several options available, surgeons can utilize whichever method is most suitable for their patients. There is no one absolute best method of nipple reconstruction for all patients. Some patients are comfortable without having a nipple, and do not wish to have further surgery. Others choose the non-surgical option of tattooing without reconstruction. This allows color pigmentation to simulate the nipple areola without the contour of an actual nipple. Still, the reconstruction of the nipple areola helps to put the finishing touches on the new breast after a long journey in reconstruction.

After optimal symmetry between the breasts has been achieved, the nipple areola reconstruction can be done. There are a number of factors that help determine which method of nipple reconstruction is right for you. These include the quality of tissue on the reconstructed breast, and whether you are having nipple reconstruction with or without a surrounding graft. Even more important, is your surgeon’s preference.

Historically, one technique included sharing a piece of the nipple from the opposite breast. This surgery is not used today, because it transfers breast tissue to the reconstruction that could potentially form a new cancer. Another method used in the past involved taking a full thickness skin graft from the labia to create a dark colored areola. This outdated technique leaves a scar in an undesirable location. Also, these grafts may be hair bearing, and areolar pigment is easier achieved with medical tattooing.

In modern approaches to nipple reconstruction, the nipple mound is created from skin taken as a local flap on the reconstructed breast. Various local flaps have been described, including the Skate flap, the C-V flap and the Star flap. Regardless of which approach your surgeon chooses, the outcome will be a nipple mound. The areola can then be either tattooed, or it can be reconstructed with a skin graft taken from elsewhere on the body. Common donor sites for the graft include the abdominal scar from a flap reconstruction, the inner thigh, or the buttock crease.

Nipple Areola Reconstruction (Skate Flaps and Skin Graft)

Nipple Areola Reconstruction

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All nipple reconstructions lose some projection over time as part of the normal wound healing process. The risk of wound complications in nipple reconstruction is very low in patients with no history of prior radiation, but common in the radiated breast. In the case of failed nipple reconstruction, it may be necessary to revise the reconstruction with another local skin flap. Sometimes, the use of dermis or fat grafts, and fillers such as Radiesse, may be necessary to improve nipple projection. AlloDerm® has also been utilized by some surgeons at the time of nipple reconstruction to maximize projection and correct flattening.

Nipple reconstruction is done as an outpatient, ambulatory procedure. The rate of recovery depends on what other revisions are done simultaneously, and where the donor site for the areola graft is located. Once you have healed, you will have the tattooing done in your surgeon's office. Refer to the Nipple Areola Tattoo section for details on this procedure. Also you may refer to the Post-Operative Nipple Reconstruction section to learn about care after nipple surgery.

Photos and Doctor Commentary
 

Nipple areola reconstruction after bilateral TRAM flaps

Nipple Areola Reconstruction

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This patient underwent bilateral mastectomies and TRAM flap reconstruction.  Her nipple reconstruction was completed with skate skin flaps.  Each areola is a skin graft taken from the healed TRAM flap scar on the abdomen. This is the final appearance after nipple areola tattoo.

 

Nipple areola reconstruction after bilateral expander implants

Nipple Areola Reconstruction

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This patient underwent bilateral mastectomies and expander implant reconstruction.  Both nipples were reconstructed with skate skin flaps and each areola is a skin graft taken from her abdomen.  The photo on the left is before nipple tattoo.  The photo on the right is the final appearance after nipple areola tattoo.