- 1 Description
- 2 Options
- 3 What is A Normal Nipple-Areola Complex?
- 4 Indications
- 5 Evaluation
- 6 Option Details
- 7 Procedure Details
- 8 Recovery
- 9 Frequently Asked Questions (FAQs)
- 9.1 What is nipple and areola reconstruction?
- 9.2 Can my natural nipple be reattached to my new breast mound?
- 9.3 When can I have a nipple areola reconstruction?
- 9.4 Is nipple and areola reconstruction required after breast reconstruction?
- 9.5 Why should I have nipple areola reconstruction?
- 9.6 Which nipple reconstruction method is best for me?
- 9.7 Is nipple areola reconstruction surgery permanent?
- 9.8 Will my nipple flatten after reconstruction surgery?
- 9.9 Is reconstructive breast surgery considered a cosmetic procedure since implants are involved?
- 9.10 When is a nipple areola performed?
- 9.11 What is the difference in time for nipple areola reconstruction if a patient has to undergo chemotherapy?
- 9.12 How is nipple reconstruction performed without a skin graft?
- 9.13 How long is the recovery from a nipple areola reconstruction surgery?
- 9.14 What is the nipple areola reconstruction graft technique?
- 9.15 What is the flap approach?
- 9.16 How long will I have to miss work after a nipple areola reconstruction?
Breast reconstruction involves one or more surgical procedures performed to rebuild and restore all of the elements of a woman’s breast after mastectomy. Creating the nipple areola complex is the final step of the breast reconstruction process, and completes the vision of a natural-looking breast mound. When building a nipple areola complex, the plastic surgeon focuses on matching the areola to the new breast in terms of: size, shape, texture, color, projection, and position. This final element is incredibly important, because it often brings a sense of fulfillment and completion to a woman’s breast reconstruction journey.
At Gabbay Plastic Surgery, Dr. Joubin Gabbay M.D. understands the pivotal importance of nipple areola reconstruction, and utilizes the most cutting edge surgical techniques and equipment in order to ensure that his patients surgical reconstruction expectations are not only met, but are vastly exceeded.
Initial breast reconstruction surgery does not include nipple and areola creation—this surgery is performed as a separate procedure, usually performed 3-4 months after your initial reconstructive procedure. The timing of the surgery may vary, depending upon the specific techniques utilized during your breast reconstruction.
Although numerous techniques have been developed to reconstruct the nipple following mastectomy, the majority of procedures involve rebuilding the nipple from the patient’s own skin overlying the new breast mound, and reconstructing the areola using tattoos or skin taken from other areas of the body. Once the initial reconstructed nipple healing is complete, the areola area is tattooed with micropigmented ink, in order to complete the picture of a naturally beautiful breast.
Although nipple areola creation is not considered a mandatory part of the breast reconstruction process, patients often elect to undergo a nipple areola reconstruction because it adds the “finishing touch” to the overall appearance of a woman’s natural breast, and provides a true sense of completion to the overall breast reconstruction process.
At Gabbay Plastic Surgery, Dr. Gabbay is highly experienced performing reconstructive breast procedures, and is honored to help women restore a high level of self-confidence with nipple areola reconstruction. If you would like additional information about nipple areola creation, or any form of breast reconstruction surgery, please call Gabbay Plastic Surgery today and let us schedule your complimentary initial consultation with Dr. Gabbay.
What is A Normal Nipple-Areola Complex?
The nipple is the elevated structure located in the center of the areola (the pigmented skin surrounding the nipple) on the breast mound. Its color is determined by the thinness and pigmentation of the skin. Nipples are classified primarily by their shape, and may be considered: small or large; short or long; round or cylindrical; and flat, prominent, or inverted. If the nipples project from the breast they are considered to be prominent; if they are positioned flush to the areola they are considered flat; and if they are depressed into the breast, they are referred to as “inverted” nipples.
In terms of nipple aesthetics, the nipple should have a projection and diameter that appears proportional in relation to the patient’s areola and breast size. The areola is usually a different hue than the skin on the breast itself, and varies in color, from slightly lighter than the breast skin (pink) to a very dark (nearly black) shade, with the color usually determined by pigment of the skin on the rest of the patient’s body. The diameter and color of the areola are genetically pre-determined, but the areola can increase in size should the breasts increase in size. The average areola measures 3-5 cm in circumference; however, some patients have areolas extending 8-10 cm in circumference.
Puberty, pregnancy, and menopause can all cause aesthetic changes to the nipples and areola. In puberty, the areolar shape is generally symmetrical. The areola increase in size when the breasts increase in size, and during pregnancy, the areola widens as the breasts fill with milk, and become darker to make it easier for the baby to see where they are to receive nourishment. After breastfeeding is completed, the nipple and areola can return to pre-pregnancy shape and size.
Nipple and areola reconstruction and restoration is often indicated following trauma to the breast, or after breast reconstruction following breast cancer. Although technically considered an elective procedure, many patients elect to undergo nipple and areola reconstruction as the last step in their breast reconstruction journey. The nipple and areolar reconstructive process usually begins several weeks (or months) after the initial breast reconstruction is completed and the new breast has healed. Numerous studies have shown that the level of post-reconstructive surgery satisfaction is much higher for women who have had nipple-areola reconstruction than for those who did not.
Nipple areola reconstruction is also utilized to treat burn victims, to correct asymmetric nipples due to breast surgery or aging, and to correct inverted nipples or enlarged nipples that appear disproportionate to the rest of the breast. It is important to understand that in some cases, reconstructed nipples will not have the same sensation as natural nipples; however, with the advances in reconstructive cosmetic surgery, many women can have natural looking nipples with high quality nipple sensation.
During your initial consultation at Gabbay Plastic Surgery, Dr. Gabbay will discuss your nipple reconstruction options, and how best to achieve your desired surgical results. You should come to the meeting prepared to discuss your full medical history, including any medical conditions, drug allergies, current medications, and previous surgeries or treatments you have had, as well as your current alcohol and tobacco use.
To determine which procedure is best for you, Dr. Gabbay will conduct a thorough examination of your breasts. If it is determined that you are a candidate for nipple-areola reconstruction, Dr. Gabbay will educate you regarding the details of the surgery, its risks and benefits, and will provide you with pertinent pre- and post-operative care instructions. Before your surgery, an X-ray and mammogram will be taken, in order to screen for cancer or other breast abnormalities.
Graft Reconstruction Technique
The graft technique involves harvesting skin from a donor site such as the remaining nipple tissue, earlobe, labia, the abdominal scar from a flap reconstruction, the inner thigh, or the buttock crease. Typically, the patient’s remaining nipple is the preferred donor site, as it provides the best match in terms of skin texture and color—except in the case where a patient has had a bilateral mastectomy—for this situation, the other donor sites are more appropriate.
Flap Reconstruction Technique
In the flap approach to nipple reconstruction, the nipple mound is created from a “flap” of skin taken directly from the skin adjacent to the site of the newly reconstructed nipple. This technique has the advantage of keeping the blood supply intact. The flap reconstruction technique also confines any scarring to the area of the new nipple and areola, as opposed to the graft technique, which creates a new scar at the donor site.
Micropigmentation (Tattooing) Reconstruction Technique
Micropigmentation is a technique utilized to complete the aesthetic look of the newly constructed nipple-areolar complex. Once the nipple-areolar reconstruction has been completed and had time to heal, the color match will be reviewed. If the patient is dissatisfied with the color of the reconstructed nipple-areolar complex, a simple tattooing procedure may be recommended. The tattooing procedure, called micropigmentation, is primarily used to simulate the color, shape, and texture of the areola, and is performed with equipment that is very similar to what one might find at a tattoo shop. Micropigmentation tattooing is a relatively quick and simple outpatient procedure, requiring only local anesthesia, and does not create an additional scar. Contrarily, micropigmentation can be used to camouflage the color, and even soften the texture of existing scars left behind after the initial breast reconstruction procedure.
During the micropigmentation tattooing reconstruction, various pigments are utilized to complement your skin tones and/or to match the color of your previous nipple. In some cases, this may require more than one procedure, and, as with any tattoo, the pigment may eventually fade, necessitating a return visit for a color touch-up.
Nipple Areola-Sparing Mastectomy
The field of breast reconstruction is continuously evolving, and one of the more notable surgical advances in breast cancer treatment is the nipple-areola-sparing mastectomy, along with immediate reconstruction of the breast mound using implants. As the name indicates, the nipple-areola-sparing mastectomy is performed in order to preserve the patient’s nipple-areola complex, thereby eliminating the need to reconstruct the nipple-areola complex after the initial surgery. There are many factors to consider before undergoing this surgery, and only your surgical oncologist can determine if you are a good candidate for this particular type of mastectomy.
For patients who have lost their breasts to mastectomy, the nipples and areola can be reconstructed surgically through several techniques. Nipple-areola reconstruction surgery is performed on an outpatient basis, under local anesthesia, and generally takes 1-2 hours to complete.
In most cases, nipple and areola complex reconstruction is performed after the breast mound swelling has diminished, and the shape of the breast has settled, because premature placement of the nipple and areola could cause it to be placed either too high or too low.
The most common technique employed for surgical nipple reconstruction is the flap technique. For this procedure, Dr. Gabbay will mold the shape and size of the breast skin into a new nipple, outlined on the peak of the breast mound. In some cases, part of the nipple from the opposite breast will be utilized to fashion a nipple for the new breast.
Once the nipple has been reconstructed, the areola may be recreated by harvesting skin from a location of the body that has a natural tendency to darken as it heals, after being grafted. Following this procedure, a bolster dressing will be applied, securing the areola graft in place, and protecting the nipple for 4-6 days following surgery. Once healed, color can be added to the reconstructed nipple and areola using the micropigmentation techniques explained above.
The rate of recovery from breast reconstruction surgery is dependent upon what other revisions are performed simultaneously, and where the donor site for the areola graft is located. Following surgery, a bandage is typically applied to minimize swelling and pain, and medication is administered to control discomfort, along with antibiotics to reduce the risk of infection. Some bruising and swelling may occur, but this generally subsides 2-3 days after the procedure. It is crucial to the healing process that you follow the post-operative instructions provided by Dr. Gabbay, which will describe in detail that proper bathing and sleeping techniques. Although most patients return to work after a few days, it is imperative that you avoid any physical contact involving the nipples. Nipple sensitivity may be expected for at least one month after surgery. All scars, however minimal, may never fully disappear, but should fade significantly after several months.
Although rare, as with any surgery complications can occur and for nipple areola reconstruction they can include:
- Nerve damage
- Loss of nipple sensation
- Excessive bleeding
- Permanent scarring
- Wound breakdown
- Malposition of the new nipple
- Shrinkage or excessive flattening
- Additional scars on the breast mound
- Poor skin-graft take
Frequently Asked Questions (FAQs)
What is nipple and areola reconstruction?
When cancer patients undergo a complete mastectomy, the entire breast and all associated parts are removed and a nipple areola reconstruction surgery can re-create the look of your natural nipple and areola, using skin and muscle tissue from different areas of your body. To make the color more natural, the new nipple and areola area can be darkened using tattooing pigmentation.
Can my natural nipple be reattached to my new breast mound?
While there are some instances where a nipple and areola can be saved if the cancer has not affected the nearby cells, it is not usually the best course of action, due to risk of cancer recurrence and difficulty in attaching the tissue properly. In most cases, remaking a nipple and areola looks more natural than trying to reattach the natural nipple and areola.
When can I have a nipple areola reconstruction?
Nipple and areola reconstruction usually takes place about 3-4 months after the initial implant surgery, so the breasts have had a chance to heal. Allowing time for the swelling to subside and the breast to “settle” enables Dr. Gabbay to place the nipple so that it matches the position of the nipple on the other breast if applicable.
Is nipple and areola reconstruction required after breast reconstruction?
Nipple and areola reconstruction is an optional portion of the breast reconstruction process, for patients who want their breast to look as real and natural as possible.
Why should I have nipple areola reconstruction?
Many women who have undergone a breast reconstruction after breast cancer feel like the process is not complete until their breast has a nipple-areola complex. For a woman who has lost one breast, the reconstructed breast will match the natural breast more closel,y and the shape of the nipple will be the same on both sides.
Which nipple reconstruction method is best for me?
During your initial consultation, Dr. Gabbay will discuss the different options that will best suit your goals of reconstructive surgery, and he has earned the respect of numerous patients by producing the quality results that they deserve and desire.
Is nipple areola reconstruction surgery permanent?
Nipple reconstruction surgery is considered a permanent surgery, although, it is possible that your nipples may re-shape at a later time for various reasons possibly requiring breast revision surgery.
Will my nipple flatten after reconstruction surgery?
Some women report the flattening of their nipples after undergoing reconstructive surgery and this is typically caused by something that occurred during the healing process. After surgery, until the nipples have completely healed, it is important not to wear tight clothing or bras because this will push up against your recovering nipples causing them damage. It is crucial to follow all of the post-surgery instructions provided by Gabbay Plastic Surgery.
Is reconstructive breast surgery considered a cosmetic procedure since implants are involved?
Breast surgery is not always concerned with size and cosmetic manipulation, but after recovering from breast cancer and undergoing a mastectomy, most cancer patients opt for implants to reconstruct their breast(s), and choosing to also have nipple and areola reconstruction gives their new breast a natural look. Gabbay Plastic Surgery offers a variety of cosmetic and reconstructive procedures, and Dr. Gabbay is committed to working with you, whether after cancer, or for other reasons to help you achieve your desired results, so you can regain your self- esteem and confidence.
When is a nipple areola performed?
The timing of nipple reconstruction depends on both the type of breast reconstruction a woman has and the cancer treatment prescribed. The expander/implant and flap reconstruction procedures help recreate the breast mound and after a patient recovers from that surgery, a separate procedure is needed to recreate the nipple and areola.
What is the difference in time for nipple areola reconstruction if a patient has to undergo chemotherapy?
Patients undergoing radiation will typically have to wait 3-6 months for the effects of radiation to resolve before having nipple reconstruction, and for implant reconstruction, twelve weeks usually provides enough healing time for nipple areola reconstruction to be performed.
How is nipple reconstruction performed without a skin graft?
The illusion of a nipple areola complex can be created using medical tattooing.
How long is the recovery from a nipple areola reconstruction surgery?
Nipple reconstruction is performed as an outpatient procedure, The rate of recovery depends on what other revisions are done simultaneously, and where the donor site for the areola graft is located. The healing process varies with each patient and following post-healing instructions will speed up the recovery time.
What is the nipple areola reconstruction graft technique?
The graft technique involves harvesting skin from a donor site separate from the reconstructed breast and the skin graft is then attached to the site of the newly constructed nipple and/or areola. Common donor sites for areola grafts include the abdominal scar from a flap reconstruction, the inner thigh, or the buttock crease; and for nipple grafts; the three most common donor sites are the patient’s remaining nipple, earlobe, and the labia.
What is the flap approach?
In the flap approach to nipple reconstruction, the nipple mound is created from a “flap” of skin taken directly from the skin adjacent to the site of the newly reconstructed nipple and this technique has the advantage of keeping the blood supply intact and confining any scarring to the area of the new nipple and areola.
How long will I have to miss work after a nipple areola reconstruction?
Reconstruction of the nipple and areola is typically an outpatient procedure, requiring 1-2 hours to complete. Most patients will have some mild pain or discomfort, which may be treated with medication, and many patients return to their normal activities within a few days. As with all surgical procedures, it is important to understand that these guidelines can vary based on a patient’s personal health, the techniques used, and other variable factors surrounding the surgery. It is important not to subject the procedure sites to excessive force, abrasion, or motion during the healing period.