Nipple Reconstruction “Lets Dot the i “

Congratulations for making it this far in your reconstructive process. Creating the nipple and areola is the final component of making your breast reconstruction complete.

Historically numerous methods of nipple reconstruction have been described, from the tip of a toe, earlobe, labia part of the vagina to any type of implantable material. Luckily for us nipple areola reconstruction over the centuries have progress to a far less dramatic procedure.

There if no one absolute best method of nipple areola reconstruction. Some patients are comfortable without a nipple and elect not to have a reconstruction. Still the reconstruction of the nipple and the areola helps to put the finishing touches on the new breast after a long journey of reconstruction.

The nipple reconstruction takes place about three to six months after the final breast reconstruction. The time delay allows for the effects of gravity, and improved symmetry between the breasts. The type of reconstruction depend on the quality of the surrounding skin, the surgeon and patient preference.

Modern tattoo techniques are such that a very good 3 dimensional reconstruction of the nipple and areola may be achieved with a tattoo. A nipple tattoo avoids the need for a surgical procedure and is done by a trained tattoo artist.

The surgical creation of a nipple areola reconstruction comprises two parts. Firstly nipple reconstruction and secondly areola reconstruction, multiple options exist for both.

You may reconstruct the nipple either by nipple sharing or by skin from the breast. Nipple sharing requires the presence of a normal nipple of adequate size and volume so as to be shared between two breasts. The reconstruction provides excellent symmetrical colour and texture match but unfortunately requires scarring and sensory loss of the normal nipple.

The second reconstructive option utilizes various combinations of local breast flaps to create a protrusion similar to a nipple. The local flaps provides a very good reconstruction.  Unfortunately the newly reconstructed nipple may suffer some volume loss over time thus the initial nipple will be reconstructed slightly larger.

The areolar reconstruction involves the removal of skin from the lower tummy. A skin graft is taken from the lower tummy by a process similar to a “mini-tummy-tuck”. Once the skin graft is healed the patient may elect to have a tattoo done by our units tattoo artist. The tattoo provides excellent symmetrical colour match. Unfortunately the tattoo may fade over time requiring a repeat tattoo.  Another option in creation of the areolar or brown area around the nipple is to tattoo a circle around the nipple a good option in patients that do not have a tummy scar.

All nipple reconstructions loose projection or flatten 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 is common in the radiated breast. Sometimes the use of fat graft or fillers may be used to reverse the failures.

Nipple reconstruction is a day procedure. The rate of recovery depends on what other revisions are done simultaneously and the healing of the donor site.