Nipple and Areola Reconstruction — The Final Step
20 Feb 2016
Regardless of the method a woman chooses, nipple and areola reconstruction can help a breast cancer patient feel comfortable with her new breasts. For women who’ve faced breast cancer, nipple reconstruction is one more way to take charge.
The nice thing about nipple/areola reconstruction is there’s no urgency–a woman can make the choice whenever she’s ready. Some women find they are content without having a nipple at all, while others choose a form of reconstruction that does not require surgery.
Types of Nipple and Areola Reconstruction
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 patient is a candidate for nipple reconstruction is the quality of the tissue at the reconstructed breast. Patients with inadequate tissue or radiation damaged skin may not be good candidates for certain types of reconstruction.
As with all breast reconstruction options, there is no one specific technique that is perfect for everyone. Reconstruction decisions should include a plastic surgeon who can provide guidance and information specific to your situation.
Surgically Created Nipples
A surgeon forms a new nipple to match the other side (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. Your plastic surgeon can help you determine what is the best method for your individual situation. 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 and the sides are pulled together.
After the created nipples have healed, tattooing can be implemented to replicate the color and suggest the texture of the nipple and areola of the other breast. The tattooing procedure, called micropigmentation, is usually the final stage of a complete nipple reconstruction.
Another nipple reconstruction option is a dermal implant. Tattoo artist, Eric Catalano, developed this new nipple reconstruction technique. The tattoo artist inserts a small dermal implant under the top layer of skin in the center of the tattooed areola, leaving a tiny post extending above the surface of the skin. The tattoo artist then screws a silicone nipple, created to match each patient’s coloring, into the post. Patients say the look and feel of the prosthetic is amazingly realistic.
The 3D effect of areola pigmentation is a popular choice, whether or not the women first opt for surgical reconstruction. Advanced tattoo techniques involve shadowing, highlighting, feathering, and contouring. Color selection and blending is vital for a natural looking result. It’s important to find a tattoo artist experienced in nipple and areola tattoos, such as the tattoo artists associated with P.ink.
Additionally many women with scars from their mastectomies or reconstructive surgeries choose to have a design tattooed 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.
Alternatives to Nipple Reconstruction
If more surgery and/or tattoo needles is not something you are ready to consider at this time, you may want to look into a few alternatives to nipple reconstruction. Depending on where you are in your cancer treatment, you have a few options.
If you have not yet had your mastectomy and your breast cancer is low-risk and not near the skin or nipple, you may be eligible for a nipple-sparing mastectomy. There is absolutely no more realistic end-result than keeping your originals! Be sure to ask your surgeon if this type of mastectomy could be an option for you.
Perhaps your mastectomy and breast reconstruction is already finished, but you are not interested in additional surgery or the idea of tattoo needles to try to recreate nipples. You might want to consider non-invasive nipple prosthetics. These prosthetics work like waterproof “stickers,” and they last for weeks at a time. Future articles will discuss both of these alternatives, so stay tuned!
Don’t Forget Insurance
The Women’s Health and Cancer Rights Act of 1998 requires insurance to cover post-mastectomy reconstruction, including areola/nipple tattooing. Insurance will often reimburse your costs, including for reconstruction tattoos, so be sure to ask for insurance forms from physicians and other post-mastectomy providers.