Nipple reconstruction or areola reconstruction surgery is usually performed at a later stage of breast reconstruction surgery. There are various techniques for nipple reconstruction after mastectomy to recreate the nipple and areola.
What is Nipple Reconstruction Surgery?
After a mastectomy, you may have both or one of your nipples removed. Nipple reconstruction is considered the last phase of breast reconstruction. Breast reconstruction can include the following procedures:
- Breast implants
- Breast reconstruction using a tissue flap
- A combination of breast reconstruction techniques
In most cases, you can have nipple reconstruction surgery following breast reconstruction using surgery, nipple tattooing, or both. You may also require nipple reconstruction following trauma, Some individuals find that a nipple reconstruction is a crucial final step in their breast reconstruction, while others do not. The decision to undergo nipple reconstruction surgery is an entirely personal choice and one that you don’t need to rush.
Rarely a surgeon may perform a nipple reconstruction at the same time as part of your breast reconstruction surgery. Typically this isn’t recommended as it could result in poor positioning of the new nipple.
Nipple Reconstruction Surgery: Quick Overview
Types of Nipple and Areola Reconstruction
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.
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.
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 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.
When Can You Have a Nipple Reconstruction After Mastectomy?
It’s best to wait at least 4-6 months after your breast reconstruction before having a nipple reconstruction. You need time for your breasts to settle into their new position and heal. You also want to be completely happy with your breast reconstruction before starting nipple reconstruction.
Who is a Suitable Candidate for Nipple Reconstruction Surgery?
Individuals who have had breast reconstruction with either breast implants or tissue flap are suitable candidates for nipple reconstruction surgery. You should also be a non-smoker.
How to Prepare for Nipple Reconstruction at the Harley Clinic
Typically, nipple reconstruction uses a local anaesthetic, and you can expect to go home the same day. Before your surgery, your plastic surgeon will give you instructions to follow, such as:
- Don’t eat or drink for a certain time before surgery
- Wear loose and comfy clothes
- Avoid taking medications on the day of the surgery
Areola Reconstruction Surgery Recovery and Aftercare
After nipple reconstruction, you will go home with bandages around the area. You will need to keep the area dry for the first 48 hours. After that, you can shower. Make sure to gently pat the area dry and avoid rubbing it. Your doctor will advise you on how to take care of your new nipples. Usually, it involves an antibacterial ointment and using some cotton inside your bra to protect your nipples.
Typically, one week after your surgery you will come back to the Harley Clinic for a follow-up appointment. If at any point, you have any concerns, don’t hesitate to contact your surgeon. You can expect initial healing to take up to 2 weeks, and your scars will take around 3-6 months before they start fading. Full recovery takes about 4-6 weeks.
You should be able to resume normal activities after the local anaesthetic wears off, but take it easy for the first few days. If you’re interested in nipple tattooing, this usually takes place about 3-6 months after your nipple reconstruction surgery.
What are the Potential Risks, Side Effects and Complications of Nipple Reconstruction?
All surgery, no matter how big or small, carries some risk. Potential risks, side effects and complications of nipple reconstruction include:
- Failure of blood supply to the new nipple and new tissue may die
- Nipple projection will flatten overtime to some length (clothing and bras can flatten the nipples over time)