The final stage of post-mastectomy breast reconstruction is reconstruction of the nipple and the areola (the pigmented skin surrounding the nipple). This completes the overall natural look of the reconstructed breast, and in many cases also hides the scars resulting from the mastectomy and reconstruction. Although nipple reconstruction is completely optional and is not mandatory, it is still covered by insurance as part of breast cancer reconstruction. Board certified plastic surgeon Dr. Gupta encourages patients to undergo nipple reconstruction because it adds so much to the final appearance of the reconstructed breast. It also helps breast cancer survivors to feel whole once again and finally put their breast cancer ordeal behind them.
There are many different types of nipple reconstruction procedures used by plastic surgeons to reconstruct the nipple and areola. The nipple is usually reconstructed using folded-over flaps of the breast skin to create a projecting cylinder of tissue. The pigmented areola is then reconstructed using either a skin graft from the groin (where the skin is darker), or by tattooing the skin around the nipple. Dr. Gupta prefers to use the tattooing method since it avoids the pain and scarring associated with groin skin grafts. Most nipple reconstruction procedures can be performed in the doctor’s office under local anesthesia and have a very quick recovery period with very little pain.
The most important factor in successful nipple reconstruction is the location on the reconstructed breast. A properly placed nipple reconstruction restores natural breast shape and symmetry. On the other hand, if placed on the wrong part of the breast, even a perfectly shaped reconstructed nipple will detract from the final breast reconstruction result. Therefore, Dr. Gupta delays the final stage nipple reconstruction until all other breast reconstruction stages are completed, including any necessary revision or reshaping procedures. This is usually three to four months following the final stage of breast reconstruction, and tattooing is performed four to six weeks after nipple reconstruction.