Nipple reconstruction is the last step of breast reconstruction. The goal of nipple reconstruction is to make a cosmetically pleasing nipple- the reconstructed nipple will never have sensation like the native nipple did. Some patients opt to have nipple reconstruction, while others decide to forgo an additional surgical procedure; the decision is completely up to the patient, and nipple reconstruction can be done at any time (although most surgeons will wait until at least 6 months after the initial breast reconstruction to allow time for things to settle).
There are two main ways to reconstruct a nipple.
- Local tissue transfer: tissue is moved around to create the projecting part of the nipple. A skin graft may or may not be used to fill in where the areola would be, depending on the type of local tissue transfer used. (See the diagram above for a skate flap, one of the most common types of nipple reconstruction). A tattoo is later done to add the pigmentation.
- Tattoo-only reconstruction: no actual projection is created, so the nipple will look flap on profile view. Shading is done to obtain a 3-D effect, and can look very realistic.
A third option for reconstruction uses local tissue transfer in combination with an implant, such as Alloderm, to help maintain projection. Alloderm is a regenerative tissue matrix; it is cadaver skin that has had all the cells removed, leaving only the collagen framework behind. It is very commonly used in breast reconstruction, and is now gaining popularity in nipple reconstruction as well.
Plastic Surgeons are trained in both local tissue transfer and medical tattooing. The tissue flap procedure is done in the operating room, takes about an hour, and you go home the same day. The recovery is generally fairly easy, although you will have to wear a protective plastic cup inside your bra for several weeks to keep the new nipple from flattening out. The tattooing is done in the office, using numbing cream for anesthesia. You may also have a tattoo done by a tattoo artist who specializes in reconstructive tattooing.
Do you have any questions about nipple reconstruction?