Nipple reconstruction can be performed after surgical resection of the nipple or for congenital nipple defects. Most commonly, patients who undergo nipple reconstruction have lost a nipple after mastectomy or some other type of breast surgery. Sometimes, a person is born without a nipple or with an inverted nipple. Whether a person is missing a nipple due to surgery or congenital malformations, it is possible to recreate a nipple surgically.
Nipple Reconstruction after Mastectomy
The traditional mastectomy involves resecting both the nipple and the areola. The areola is the colored circle around the nipple. The nipple and the areola together are called the nipple-areola complex (NAC). After a mastectomy, breast reconstruction involves recreating the breast mound either with natural tissue or with an implant to reapproximate the shape of a breast under clothes. Unless a patient has undergone a nipple-sparing mastectomy, the reconstructed breast will not have a NAC.
For some patients, they are happy with a breast mound that does not have a nipple. They feel that they can wear clothes and bathing suits without feeling self-conscious, and that is enough. For other patients, they would like their breasts to look as normal as possible without clothes. After creating a breast mound that restores the breast shape, seeing a reconstructed nipple helps many people feel more ordinary when they look at their breasts in the mirror. Seeing a regular breast helps many patients move on so that they do not have to think about their breasts or their bodies every day for the rest of their lives.
Nipple reconstruction after mastectomy can be achieved in many different ways. One common way to reconstruct the nipple is by using a flap of skin from the surrounding breast tissue. The breast skin is then folded and reconfigured in the shape of a nipple. For patients who have unilateral breast reconstruction and have a large native nipple on the other side, a nipple-sharing technique can be used to reconstruct the nipple. Part of the large native nipple can be used and grafted to form a nipple on the reconstructed breast. Finally, an older technique of nipple reconstruction involves using a flap of skin from the groin.
After nipple reconstruction, a plastic nipple "house" is placed over the reconstructed nipple to protect the new nipple. The plastic nipple "house" is kept in place for one week. During this week, the patient cannot shower and should undergo sponge baths only. After one week, the plastic nipple "house" is removed, and it is replaced with a soft nipple dressing. During the second week, the patient can shower normally. Two weeks after nipple reconstruction, the patient does not need a dressing over the new nipple.
Over time, a reconstructed nipple is expected to lose about half of its volume. Thus, it is necessary to create the nipple that is initially larger than its final desired size. Once the nipple has healed, the NAC is completed by tattooing the surrounding breast skin to recreate the areola. Some women decide to forego the nipple reconstruction, and undergo tattooing only to create a flat NAC with a three-dimensional illusion. Ultimately, the choice is yours.
Nipple Reconstruction for Inverted Nipple
Some women have not had their nipple removed surgically, but they were born without a nipple or with an inverted nipple. For someone who was born without a nipple, a nipple reconstruction is performed in a similar fashion to a patient who has undergone nipple resection. For someone with an inverted nipple, improving the projection of the nipple can be achieved by placing acellular dermal matrix (ADM) under the nipple. After the ADM is placed under the nipple skin, it is sutured in place to give the nipple projection. The sutures dissolve over time, and the acellular dermal matrix provides substance and volume to the inverted nipple.