Nipple–Areolar Reconstruction

Nipple-areola reconstruction comprises the 2nd or 3rd stage of breast reconstruction, adds to symmetry between the two breasts and has a number of psychological advantages. Nipple reconstruction is usually undertaken at 3 to 6 months after reconstruction of the breast mound. If a patient has had radiotherapy this is done at least 6 months after cessation of radiotherapy.

The options for nipple reconstruction include the use of

• Local flaps

• Skin grafts

• Tattoo of nipple & areola

• “Stick on” – prosthetic nipples

• Nipple sharing (using a segment of the opposite nipple).

Nipple reconstruction can be performed either alone or at the same time as breast implant exchange, revision of the breast mound or balancing surgery on the opposite breast. Nipple reconstruction therefore provides the surgeon an opportunity to adjust your opposite breast if this wasn't done at the first surgery, exchange a breast expander for a definitive implant or treat capsular contracture of the reconstructed breast. It is also usual to revise any dog-ears, and undertake liposuction of the armpit area at the time of nipple reconstruction. The aim of this 2^nd stage of breast reconstruction is to improve your overall symmetry and enhance the aesthetics of the breast reconstruction. Capsulectomy and implant exchange may be undertaken at this time – as this may be required in patients who have received radiotherapy following their reconstruction. In patients who have had an LD flap breast reconstruction (latissimus dorsi flap) the bulge often left in the armpit area largely shrinks with time (as the muscle atrophies with inactivity) and does not require surgical intervention, but can sometimes persist.

As in any plastic surgery, there are benefits, risks and the final results are not guaranteed. The chance of complications following nipple reconstruction depends on the type of operation and other factors such as your general health. Professor Malata will explain how the risks apply to you. Detailed postoperative instructions will be discussed during consultation and a procedure-specific handout given to you by Professor Malata.

Some risks of nipple-areolar reconstruction

• Bleeding

• Infection

• Wound breakdown

• Loss of shape & height

• Malposition of the new nipple

• SHRINKAGE: Excessive flattening

• Additional scars on the breast mound

• Poor skin graft take if a skin graft was used

• Exposure of underlying implant & potential loss of implant

Alternatives to a nipple reconstruction

• Artificial nipple / Prosthetic nipple

• No surgery at all