Nipple and areola reconstruction is the important final step in the breast reconstruction process. Studies have shown that breast cancer survivors feel measurably more satisfied and self-confident with the presence of a reconstructed nipple-areola complex. To achieve natural-looking results, a variety of techniques can be utilized, either at the time that the breast mound is being reconstructed or, as is more frequently the case, at a later date.

For women with breast cancer, mastectomy is often a necessary element of effective treatment. While surgical removal of a breast can prevent the spread of the disease and can be a vital step toward a cure, the emotional effects of mastectomy are not as positive. To improve emotional wellbeing after mastectomy and ease the transition toward health after breast cancer survival, breast reconstruction has become a popular option. Breast reconstruction can create a positive shift in the mindset and self-image of breast cancer survivors. Studies have shown that the positive effects of breast reconstruction are not fully realized without reconstruction of the nipple and areola.

Nipple and areola reconstruction often represent a combination of surgical and non-surgical methods. For example, one of the mainstays of areola reconstruction is the use of tattoos for pigmentation. This non-surgical treatment is often accompanied by surgical flap techniques for nipple reconstruction. With the many options for reconstruction, the only way to develop an optimal treatment plan is to carefully assess the patient's individual anatomy and goals, as well as the status of their breast cancer. These factors will determine which methods of nipple and areola reconstruction will be used and when the procedure(s) will be performed.

Argument for Immediate Nipple and Areola Reconstruction

Many surgeons feel that nipple and areola reconstruction should be delayed until after breast reconstruction. Many California surgeons like myself will inform patients that waiting until this point allows the reconstructed breast to settle into place and may ensure better visual harmony between the breast mound and the placement of the nipple-areola complex. However, in other cases, if women are told that they must wait to pursue reconstruction of the nipple and areola, they will never complete that stage of reconstruction. Many of these women have been exposed to surgery on multiple occasions and are reluctant to "go under the knife" yet another time.

Given the positive effects of nipple and areola reconstruction, there's a strong argument to be made for doing everything possible to ensure that women do not miss this important final step, so many surgeons advocate for immediate nipple reconstruction.

Nipple Reconstruction

* Methods for reconstruction. Many surgeons use flaps of local tissue (i.e. star flap, skate flap, bell flap) to create a 3-dimensional projecting nipple. Other surgeons use donor tissue (i.e. AlloDerm® Regenerative Tissue Matrix) and injectable fillers. Still others use excess tissue during a primary TRAM flap breast reconstruction procedure to immediately create a projecting nipple.

* Special considerations. Some women may see a loss in nipple projection over time - this is less frequent with certain methods of nipple reconstruction (some flap techniques) and is reversible with a secondary procedure.

Areola Reconstruction

* Methods for reconstruction. Skin grafts from other body areas can be used to create a reconstructed areola; however, these techniques are overshadowed by improved tattoo techniques. Tattoos are a very popular method of areola reconstruction and can be used to create definition and pigmentation.

* Special considerations. If tattoos are used for areola reconstruction, some women may see changes in pigment over time. This is reversible with touch-up procedures.

Creating Symmetry

The presence of a nipple and areola on the healthy breast (contralateral) can either assist or challenge the reconstructive surgeon. It can act as a natural template for the reconstructed nipple-areola complex. However, creating a reconstructed nipple and areola that are aesthetically identical - or at least largely similar - and will continue to be aesthetically identical over time can be a distinct challenge. There are several tools that an Orange County breast surgery specialist can use to create symmetry: areola reduction of the contralateral nipple, using a tattoo pigment for the reconstructed nipple that is slightly darker than the contralateral nipple (to accommodate fading), and the creation of a reconstructed nipple that is initially slightly larger than the ultimate optimal size (to accommodate the possible loss of size and projection).