Nipple Reconstruction Surgery

There are several techniques that can reconstruct the nipple to restore both projection and pigmentation. 

Nipple reconstruction is usually performed under local anaesthetic as an outpatient procedure. So, you can expect to go home the same day as your surgery. Before your procedure, the surgeon will mark your new nipple position. Together, you will make any adjustments needed until you are happy. 

Skin Flap 

With a skin flap nipple reconstruction, the surgeon fashions a nipple from the skin of the reconstructed breast using ‘arrow’ or ‘star’ flaps. These terms describe the shape of the tissue that’s cut and stitched to the breast to form the new nipples. The idea is that this technique uses the same colour skin, so as not to replace the colour of the areola. They will make your new nipple bigger than normal, as it’s common for the nipple to shrink over time. 

Within this type of areola reduction, there are various techniques. Over the last 30 years, numerous techniques and modifications have come to light to increase patient satisfaction and results. The star and arrow flaps are some of the most commonly used techniques. 

The arrow flap allows for direct closure but has a further vertical scar that you can cover with a nipple tattoo. Researchers found that the arrow flap retains better nipple projection compared to the modified star flap. You can use the arrow flap technique in both breast implant and autologous (uses tissue, skin, fat, and sometimes muscle from another part of the body) breast reconstructions. 

The main benefit of nipple reconstructive surgery is that it can create nipples that project from the body and breast. Some individuals find that this gives them a more natural look. The downside of the surgery is that you may feel like you don’t want another surgery at this point. 

The surgery can provide a great cosmetic outcome, but you won’t have the same nipple sensation. It won’t look and feel like your original nipple. The reconstructed nipple won’t react to temperature or touch in the same way as a natural nipple. 

Skin Graft 

Another way to reconstruct the nipples is through a skin graft. The surgeon would take skin from a donor site, like the inner thigh. The skin is then grafted onto the breast. This option would leave you with a wound at the donor site. On average, the scar at the donor site would be about 5-6cm long and would fade over time. 

If you have a mastectomy on only one breast, your surgeon may use a nipple sharing technique. This is where the surgeon takes part of the remaining nipple to create the new nipple. You can create an areola by tattooing at a later time. 

Nipple Tattooing 

Nipple tattooing can be used as a standalone procedure or after nipple reconstruction surgery. You can use tattooing techniques to reproduce the appearance and colour of the nipple. It can create shading and give an illusion of a nipple.