How is a nipple reconstruction performed?
When considering nipple reconstruction, it is first important to remember that the nipple is the projected “bump” on the breast and is surrounded by the pigmented areola. There are several forms of nipple reconstruction. They are often performed with the patient under local anesthesia because the reconstructed breast has decreased sensation. The nipple typically is made from the patient’s own tissues although other options to fill the nipple with cartilage, the patient’s own fat, or an injectable filler also exist.
The nipple is reconstructed using the patient’s own breast skin. Skin and a thin layer of fat are surgically raised up to make a projecting nipple. Two pieces of skin and fat shaped like a “V” form the sides of the nipple while a third piece of skin shaped like a “C” forms the cap. All of these pieces of skin remain attached to the body to maintain blood flow and keep these flaps of skin alive. The newly formed nipple is kept in place with sutures, and a bulky gauze dressing is placed over it for protection for about 3 to 4 weeks.
Stitches are typically removed 2 weeks later. The areola is usually reconstructed 4-8 weeks after the nipple with a tattoo or less commonly at the same time as nipple reconstruction with grafted skin from the labia or pigmented inner groin skin.