Definition & Overview
Nipple reconstruction is a procedure performed to either create a new nipple or restore its normal appearance usually after a mastectomy or in conjunction with breast reconstruction surgery.
Who Should Undergo and Expected Results
Nipple reconstruction is recommended for those who have undergone mastectomy, a surgical procedure wherein one or both of a woman’s breasts are removed to treat or prevent the development of breast cancer.
Studies show that breast cancer is the most common cancer that affects females. If the tumour is large or widespread, the best and most effective form of treatment is a mastectomy.
The procedure can also be performed on women who have a high risk of developing the disease, such as those who:
Have a strong family history of breast cancer, such as if their mother, sister, or daughter was diagnosed with the disease before age 50
Are positive for BRCA1, BRCA2, PALB2, CDH1, PTEN, and TP53 gene mutations
Received radiation therapy on the chest area before age 30
Have breast microcalcifications or tiny calcium deposits in breast tissue
All patients who undergo a mastectomy can take advantage of a nipple reconstruction procedure, except in cases when a nipple-sparing mastectomy was performed, which preserves both the nipple and the areola if no cancer cells are found near them.
After a successful nipple reconstruction surgery, the patient can expect to have nipples that look and feel natural. However, this does not guarantee that the nipple will maintain its look permanently. It is normal for the reconstructed nipple to flatten out over time. If the patient also undergoes micropigmentation, the colour of the nipples can be expected to last for a few years but may also fade over time.
If the patient is not satisfied with the look and projection of the nipple, these can be improved by using fat grafts and fillers.
How is the Procedure Performed?
A nipple reconstruction procedure is performed on an outpatient basis and under local anaesthetic. It begins with the surgeon drawing some markings on the breast to guide him during the procedure, which can be performed using either of the following techniques:
Nipple flap – In this procedure, the surgeon creates the new nipple using a flap of skin from the reconstructed breast. The flap is created by making a small incision at the nipple site.
Nipple graft – This requires the surgeon to take a skin graft from another part of the patient’s body to construct a new nipple. The skin graft is commonly from the inner thigh or the crease of the buttocks.
Following the procedure, an antibacterial medication-filled protective cover is placed on the newly created nipple to prevent infection.
The whole procedure usually takes 30 minutes to an hour and the patient can go home once the effects of anaesthesia have worn off. A follow-up visit after two weeks will be scheduled for the removal of stitches.
Several weeks after a successful nipple reconstruction, the patient may opt to have the nipple and areola tattooed through micropigmentation to achieve a more natural shade. This takes around 30 minutes and is also performed under local anaesthesia.
Possible Risks and Complications
The risks and potential complications associated with nipple reconstruction include:
Nipple flattening – Although it is normal for the newly constructed nipple to flatten out slowly over time, in some cases, it flattens out quickly and more than expected. This can be repaired with fillers.
Tissue breakdown – This occurs when the newly constructed nipple doesn’t get sufficient blood supply resulting in tissue death. If this happens, the dead tissue will have to be removed and the nipple reconstruction procedure repeated.
Infection – As with all surgical procedures that involve incisions, there is a small risk of infection. This is why patients are given antibacterial ointment following the procedure.
Nipple projection problems
Studies show that complications are more likely among patients who underwent previous radiation therapy and implant-based nipple reconstructions.
Nevertheless, the risks associated with nipple reconstruction are fairly mild and non-life-threatening. For this reason, the procedure is considered to be relatively safe.
Satteson E., Reynolds M., Bond A, Pestana I. “An analysis of complication risk factors in 641 nipple reconstructions.” The Breast Journal. http://onlinelibrary.wiley.com/doi/10.1111/tbj.12591/abstract
Serra R., Miglietta AM., Abonante S., et al. (2013). “Skin-sparing mastectomy with immediate breast and nipple reconstruction: A new technique of nipple reconstruction.” Plastic Surgery International. http://www.hindawi.com/journals/psi/2013/406375/