Modern techniques in mastectomy and breast reconstruction offer women many options.
Breast reconstruction recreates a breast mound either with implants or with the woman’s own tissue. In either case, nipple reconstruction can be performed in a separate surgery from the original breast reconstruction. Many women are candidates for nipple-sparing mastectomy, in which the nipple is preserved during the mastectomy. For women whose nipple has been removed, as in a more traditional type of mastectomy, it is still possible to surgically reconstruct the nipple to recreate a complete breast. Nipple reconstruction can be done for one or both breasts.
The Technique
There are several ways to create a new nipple and areola. The most common technique for nipple reconstruction uses the remaining breast skin after a mastectomy. The skin is folded and sutured to form a new nipple, and then the new nipple and surrounding skin is tattooed to create the nipple-areola complex. If there isn’t enough healthy skin to create a new nipple from the remaining breast skin, a skin graft may be used from another site, usually the groin. The skin graft is then folded and sutured to create a new nipple.
For patients who undergo a unilateral mastectomy and have a large nipple on the remaining breast, a nipple-sharing technique may be used in which part of the native nipple is resected and transferred onto the reconstructed breast. In each type of nipple reconstruction, the nipple is often dressed with antibiotic ointment and a special medicated gauze dressing that is then placed into a protective shield or “nipple house” that remains in place for a week.
After the reconstructed nipple has healed, tattooing may be used to add color and create the areola. Some women forego nipple reconstruction altogether, and instead choose 3D tattooing to create the illusion of a nipple on the breast mound.
Quality of Life
Many women feel that breast reconstruction improves their quality of life. Surgical advances make it possible to create a soft, warm, natural breast that can be difficult to distinguish from a woman’s own breast. Many women would like to look normal without clothing. They feel that a breast that looks more like their original breast will help them put cancer behind them. Nipple reconstruction helps many women move on from their mastectomy and feel that they have restored their breast for a more confident future. If a woman is interested in undergoing a nipple-sparing mastectomy and state-of-the art perforator flap breast reconstruction she would be wise to bring this up with her physician prior to surgery as not every doctor performs the surgery necessary to make this possible.
Constance M. Chen, M.D., is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. const
