You are now nearing the end of your breast reconstruction and are considering the possibility of nipple areola reconstruction. This is a procedure that is usually performed under general anesthesia or sedation as an outpatient at the hospital. Federal law mandates that this procedure is covered by insurance companies.
The new nipple is usually created from the skin of the reconstructed breast mound. Nipple reconstructions tend to shrink over time, so your new nipple will be larger than your natural nipple so that when it shrinks, hopefully it will end up the same size. Sometimes the nipple may need to be plumped from time to time with an injection. The areola (the brown or pink part of the skin around your nipple) is reconstructed with a skin graft. This skin graft can be harvested from either the inner thigh or abdomen. Inner thigh skin tends to be a little bit darker and a better texture match for normal areola skin. The incision is well hidden but more painful and slower to heal because it is in an uncomfortable place in the crease of where your thigh joins your pubic area. Care will be taken not to harvest this skin from an area that has much hair to prevent transferring this up to your chest wall.
The alternative to inner thigh skin is to use abdominal wall skin. Abdominal wall skin is lighter than inner thigh skin, so this will have to be tattooed at a later date. This means another procedure, although this would be performed in the office. The advantage of abdominal wall skin is that this donor site has virtually no discomfort post-operatively. It may be preferred in bilateral reconstructions where a lot of skin is necessary or when the patient has a very large areola and the amount of the skin that would have to be harvested from the inner thigh is very large. If there are too many scars in the anticipated area for placement of the nipple, I may use a piece of tissue from somewhere else to make the nipple instead of a flap. This can be done from the other nipple, an earlobe, the labia, or even a large mole if you have one.
You will have a dressing over your new nipple areola reconstruction which is sewn on. This will stay in place for 5-7 days and will be removed in the office. After I take the bolster dressing off, there will be a small indentation of the skin which will disappear in the next week or so. This is because the bolster is helping the skin graft to take by pressing it in. As the months pass, the shape of the nipple and the color of the areola will finalize. Sometimes a patient will require or ask for a touch-up tattooing in the office of either her nipple or areola to give a more perfect match to the other side.
The complications associated with nipple/areola reconstruction are the following – discomfort in the thigh area and occasional opening of the incision especially if the areola graft was large. This will heal in time. Fortunately, other standard complications such as bleeding or infection or partial graft take are also unusual. If your nipple comes from the area of the breast where your mastectomy scar was, or if the mastectomy skin flaps are particularly thin, you may be at increased risk for wound healing issues. I will be glad to show you photographs of nipple areola reconstructions if this will help you in your decision. Smokers heal poorly in terms of infection and wound breakdown, and you are advised not to smoke for at least 1 month before and after the surgery. Nicotine screening may be necessary the day of your surgery. IF THE TEST IS POSITIVE, YOUR SURGERY WILL BE CANCELLED.
I hope this detailed information has not been overwhelming. The majority of patients have smooth, uncomplicated courses and are quite please with their results. It will be a pleasure to discuss nipple areola reconstruction with you. Please do not hesitate to call my office if I can be of further assistance (804-320-8545).