Nipple Reconstruction

Nipple Reconstruction

For many individuals undergoing breast reconstruction after mastectomy or breast surgery, nipple reconstruction can be an important final step toward achieving a natural and complete look. We usually perform this as part of Stage II also sometimes referred to as the revision stage.

What Is Nipple Reconstruction?

Nipple reconstruction is a surgical procedure that recreates a projecting reconstructed nipple after breast reconstruction. For women who have had a nipple removed as part of their treatment, nipple reconstruction is often the final surgical step toward restoring a natural appearance to the breast. Following reconstruction of a nipple, color can be restored with medical tattooing done in the comfort of our office. 

Surgeons use various techniques, including reshaping the skin on the breast or grafting tissue from other parts of the body to form the nipple. While this procedure does not restore sensation, it can significantly improve the aesthetic appearance of the breast.

3-D Tattoo 

Whether or not you decide to restore a nipple with a nipple-reconstruction, 3-dimensional tattoos can be done to create the most natural appearance possible. A professional tattoo artist specializing in medical tattooing can restore realistic appearing nipples and areolas after a woman’s breast has been reconstructed. We have a medical tattoo artist who regularly comes to our office to help us complete the reconstructive journey for women who choose to have this procedure done in our office. Tattooing is painless, and restoration of a beautiful and natural appealing nipple and areola help to make the reconstructed breast appear as close to a natural beast as possible. 

Who Should Consider Nipple Reconstruction?

Nipple reconstruction is typically for individuals who have undergone breast reconstruction after a mastectomy or lost a nipple due to surgery or trauma. It's a good option for those looking to restore a natural appearance to their breasts.

Emotionally, nipple reconstruction can help many patients feel more complete and confident. However, it’s a personal choice, and not all patients choose to undergo this step.

Results – Expectation vs. Reality

Nipple reconstruction can significantly improve the natural appearance of the breast, but it's important to have realistic expectations. While the reconstructed nipple adds visual completeness, it won't regain sensation. Over time, the nipple may flatten slightly, which is a normal part of the healing process.

Tattooing is often used to recreate the areola, providing a natural look, but patients should know that the color may fade over time and may need touch-ups. Most patients report very high degrees of satisfaction with the results.

The goal of nipple reconstruction is aesthetic, it’s important to be aware that the procedure does not  restore function or sensation.

The Nipple Reconstruction Procedure

Nipple reconstruction involves several surgical techniques, each designed to create a natural-looking nipple and areola. The choice of technique depends on each individual patient’s anatomy and  the type of breast reconstruction they have undergone.

Local Flap Technique

• The most common method for nipple reconstruction is the local flap technique, where skin from the newly reconstructed breast is reshaped to form a nipple. This procedure involves making small incisions in the skin and folding the skin and tissue so as to mimic the appearance of a nipple. The newly created nipple is then stitched into place.
• This method requires precise planning to ensure that the nipple is positioned symmetrically on the breast mound and that the final result looks balanced with the other breast (if applicable).

Skin Grafting

• In some cases, particularly when the local flap technique alone is not possible due to insufficient skin or tissue quality, skin grafting may be used. Small pieces of skin are harvested from another part of the patient’s body, typically from areas with thin skin like the inner thigh or lower abdomen. This grafted skin is used to help allow us to reconstruct a nipple. We use this technique only when local flaps alone are insufficient. 
• Skin grafting can be especially helpful for patients who have undergone extensive radiation therapy, as this may affect the skin's ability to stretch and heal.

3D Areola Tattooing (Micropigmentation)

• Tattooing is often used in conjunction with surgically created  nipple reconstruction to add pigment to the new nipple and to add  a natural-looking areola. 3D areola tattooing, or micropigmentation, involves injecting pigment into the skin to give the appearance of depth and color variation. This can be done after the nipple is reconstructed or as a standalone procedure for patients who do not want surgical nipple reconstruction.
• The tattooing process typically takes about an hour and can be customized to match the patient's desired color and size. Over time, the tattoo may fade, so periodic touch-ups may be needed.

Frequently Asked Questions

• Will I have sensation in the reconstructed nipple?
  No, most patients do not regain sensation in the reconstructed nipple. However, this varies slightly depending on the technique and the patient’s individual healing process. Worth noting, is that we make make every effort possible at earlier surgical steps to try to restore sensation to the reconstructed breast using “re-sensation” techniques such as nerve transfers and nerve coaptations.
• Can I undergo nipple reconstruction if I had radiation therapy?
  It’s possible but may require special considerations. Patients who have undergone radiation therapy may have more complications with healing. A detailed consultation with your surgeon will determine the best course of action.
• How long does the tattooing last, and will I need touch-ups?
  Medical tattooing can fade over time, and touch-ups may be necessary. The longevity of the tattoo depends on factors like skin type and exposure to sunlight.
• When is the best time to have nipple reconstruction?
  Many women opt for nipple reconstruction during Stage II (a few months after the primary breast reconstruction has healed), but the timing may vary based on your recovery and personal preference.

Ready to Take the Next Step?

If you’re considering nipple reconstruction or have additional questions about the process, our dedicated team at TPRSG is here to guide you. We understand that this final stage can be both exciting and emotional, and we’re committed to supporting you every step of the way.

Contact us today to schedule a personal consultation and explore your options. Together, we’ll develop a plan that fits your goals and helps you achieve the most natural, satisfying outcome possible.

 

 

There are a variety of methods for nipple reconstruction; one commonly utilized method of nipple reconstruction is illustrated here. (A) The skin and fat that will form the projected nipple are surgically raised. (B) The surgically elevated tissue is brought together to form a nipple, and all incisions are closed with dissolvable stitches. (C) The nipple reconstruction is completed. Once the reconstructed nipple is fully healed, tattooing can be used to shade the nipple and restore the appearance of the areola (not shown).

There are a variety of methods of nipple reconstruction; one commonly utilized method of autologous tissue nipple reconstruction is illustrated here. (A) The skin and fat that will form the projected nipple are surgically lifted from the breast reconstruction. (B) The tissue is brought together to form a nipple, and all incisions are closed with dissolvable stitches. (C) The nipple reconstruction is completed. Once the nipple has fully healed, tattooing can be used to shade the nipple and restore the appearance of the areola (not shown).