Nipple-Areolar Complex Reconstruction

The final stage of the breast reconstruction is the reconstruction of the nipple-areolar complex (NAC). Usually, this is performed after the nipple reconstruction, however, it may be done without it as well. While some women opt not to have anything further done after the breast reconstruction, as discussed in the last post, these relatively benign procedures are simple and easy to perform, and "complete" the breast reconstruction.

I usually perform a nipple reconstruction first if one decides to proceed with the NAC. If one foregoes the actual nipple reconstruction and only have a NAC recreated, options for such are skin grafts and tattoos. The same techniques are used if a nipple reconstruction is performed as well.

Skin grafts are usually taken from the medial thigh or groin area as the skin is typically darker in color and the donor site is hidden. The skin graft recreates a great appearance to the areola. This procedure is tolerated very well and may be done via local anesthesia or general/sedation. Little recuperation time is required afterwards.

The other popular technique is areolar repigmentation. This is done via tattoo under no or local anesthesia. Often times the NAC area is still insensate from the previous surgery, and the tattoo needle is tolerated very well. As with a tattoo, pigmentation (instead of ink), is injected into the superficial dermis to repigment the area. This, as well, gives a great appearance to the areola. This is my preferred method. I perform this with only topical anesthetic in the office as a short procedure. It also avoids another "surgical procedure".

Both techniques are very simple to perform, benign procedures with little down-time and few complications, and give excellent appearance to a reconstructed NAC.

Nipple Reconstruction

Many people have asked about what happens with the nipple and areola after the reconstruction. I do have a post on nipple-sparing mastectomy. However, if the nipple-areolar complex (NAC) is removed during the mastectomy, there are several different procedures to reconstruct the NAC to complete the breast reconstruction. I usually wait approximately 6-12 weeks after the implants are placed in order to allow the swelling to subside as well as to allow the implants to settle into their formed pockets.

There are several techniques to reconstruct a nipple. All are very effective, and basically comes down to surgeon preference. The main goal of the nipple reconstruction is to provide the appearance of a nipple as well as give the projection of the nipple. It is a very simple procedure, which usually is performed under local anesthesia alone, often times in the office in less than an hour. Downtime is minimal and local care to the incisions is all that is needed. The biggest problem with nipple reconstruction is loss of projection, usually quoted as about a 30-6-% shrinkage from immediate postoperative appearance. Various things surgeons have tried are to add a filler (e.g., fat, dermis, cartilage, or other material), in order to support the nipple and decrease the amount of postoperative shrinkage. Overall, is is a very safe and easy procedure; most women in my practice opt to undergo NAC reconstruction, as it truly "finishes" the breast reconstruction.

After these incisions are completely healed, there are various techniques to reconstruct the areola, including tattoos and skin grafts. This will be discussed next.