Nipple Reconstruction Overview
Nipple reconstruction and areola reduction are procedures used to create more aesthetically proportioned nipple-areolar complexes. Issues that can be addressed include large nipples, long nipples, and disproportionately large areolas. Additionally, the procedure is an important component and often the last step of breast reconstruction. Although the nipple and areola can sometimes be preserved, in most cases they are removed with the rest of the breast tissue. We must then rebuild the nipple and areola using autologous tissue grafts from other areas of the patient’s body (usually the upper inside thigh or abdomen), tissue on the breast itself. Lastly, tattooing can be used to create a more natural appear nipple and areola.
- Preparation: To prepare for nipple reconstruction, you should discontinue the use of blood-thinning vitamins, herbs, and medications for two weeks before the surgery. If you smoke cigarettes, you should quit for at least two weeks before and after surgery. If you are over the age of 45, medical clearance by an independent physician may be required before undergoing surgery.
- Anesthesia: If the nipple-areolar modifying procedure is being performed during or immediately following a breast reconstruction surgery, the patient will already be under general anesthesia. If the nipple reconstruction is being performed as an independent surgery, the surgeon may choose to administer either general or local anesthesia.
- Several options for nipple and areola reconstruction exist. Dr. Vallecillos will discuss beforehand which options are best for you, given your specific diagnosis and circumstances. Some of the more commonly performed nipple reconstruction procedures are as follows:
Autologous Skin Graft
Tissue from the nipple of the opposite breast can be a viable donor site for construction of a nipple when it is large enough. However, if the nipple is normal-sized or small, both nipples can end up looking diminutive.
For the areola, a tissue graft can be taken from the upper inner thigh if the skin in that area has good pigmentation. However, these grafts tend to fade in color over time, and the donor site may develop a painful scar and exhibit chronic issues with healing.
Surgical tattoo is a simple, minimally invasive and very effective means of recreating the appearance of an areola. While tattoo cannot reproduce the texture provided by a skin graft, it does allow for a more exact color match and eliminates the possibility of complications at tissue donor sites. Over time the color will fade, and the nipple and areola may need to be tattooed again.
Nipple Reconstruction FAQs
Who is a candidate for nipple reconstruction?
You should consider nipple reconstruction if you’ve undergone, or are planning to undergo, breast reconstruction. These procedures are often completed together, although nipple reconstruction can be performed after a breast reconstruction.
What is the recovery time for nipple reconstruction?
Patients should arrange to have friends, family members, or other caregivers available to help during the first week after surgery. Recovery time after nipple reconstruction depends on many factors, including whether it is performed at the same time as a breast reconstruction, as well as where donor sites for an areola skin graft (if used) are located. You should avoid having sex or performing strenuous exercise and/or heavy lifting for at least 4-6 weeks after surgery.
Are there risks or side effects with nipple reconstruction?
You should expect some temporary swelling, tenderness, bruising and possible numbness near the incision sites and throughout the breast area. These will diminish and eventually disappear with time. As with all surgeries, there is a small risk of infection and bleeding.
How long do the results last?
Nipple reconstruction is permanent, though if tattooing is used, additional tattooing may need to be performed to correct color fading over time.