Nipple and areola reconstruction can help a breast cancer survivor feel more comfortable with her new breasts. Some women find they are content without having a nipple at all, while others choose a form of reconstruction that does not require surgery.
Nipple reconstruction is only completed after the reconstructed breast has had time to heal (usually requiring three to four months) and after any necessary radiation treatment. One factor in determining if a person is a good candidate for nipple reconstruction is the quality of the tissue at the reconstructed breast.
Surgically Created Nipples
A surgeon can create a new nipple to match the other breast (if the other breast maintains a nipple) or to match photos of a patient’s past nipples or a description of her desired nipples. After the new breast has had time to heal, this procedure can be done as an outpatient with local anesthesia. Making small incisions, the plastic surgeon elevates the tissue into the correct position. A nipple mound is created, formed and shaped into a protrusion that looks natural. Often tissue from other areas of a patient’s body, such as the upper thigh or buttocks, is used to rebuild the nipple and areola. In nipple reconstruction, the surgeon will make the protrusion about twice the size as the desired end-result because the nub will shrink as it heals into place.
Several techniques can be used to create a nipple mound. Each procedure involves cutting the area in a specific pattern and folding the skin and tissue. Here are just a few examples of the many methods available:
- Skate Flap or Modified Skate Flap – An oval area is cut in the desired location for the nipple. The tissue is folded back on itself and is sometimes called the “origami” style.
- C-V Flap – Two V-shaped flaps, in continuity with a C-shaped flap, are rearranged to create the new nipple.
- Star Flap – Three points from a star shape are cut to overlap and form the nipple mound.
- Double Opposing Tab – A “Z” is made in the area where the nipple will be positioned and the sides are pulled together.
Once the created nipples have healed, tattooing (or micropigmentation) can be applied to replicate the color and suggest the texture of the nipple and areola of the other breast.
The 3D effect of areola pigmentation is a popular choice, whether or not the women first opt for surgical reconstruction. Advanced micropigmentation techniques involve shadowing, highlighting, feathering, and contouring. Color selection and blending is vital for a natural looking result.
There are also many women with scars from their mastectomies or reconstructive surgeries who choose to have an image designed and micropigmented over the scar. This action can be part of a healing process, as the woman takes ownership of her scars. A favorite flower, animal, or personalized creation can transform a woman’s scars into meaningful reminders of the life those scars won for her.
A note for survivors considering micropigmention over scars. Scars need time to heal. While some scars can take up to a year for this, others can take as much as 18 months. All scars heal at different rates based on both the injury and their body’s response. Scar tissue is much more sensitive than undamaged skin tissues, so a person can expect to “feel” pain more than they normally would, especially if the tattooing takes place on scar tissue that also has nerve damage.