Who is a candidate?
Nipple reconstruction refers to the creation of the nipple areola complex, including the projected part of the nipple, and possibly also the outline of the areola.
It is performed toward the end of the breast reconstruction process. Before one can proceed with nipple reconstruction, the work must be completed for the creation of the breast mound.
Whether this is done with implant based reconstruction or following breast reconstruction using one’s own tissues, the breast itself must be in final size and position.
This is because the appropriate position of the nipple depends on the breast shape and position, as well as the size and position of the opposite nipple so that they match.
Procedure and Incisions for Nipple Reconstruction
There are numerous methods reported in the literature for nipple reconstruction, and they vary from using local skin on the breast, to using skin grafts.
Dr. Patel’s preferred technique involves using the local breast skin in the area where the new nipple is to be located, and creating incision that allow for the creation of the projected nipple, as well as the outline of the areola.
Since the breast skin is used, the color or pigment for the nipple and areola must be added at a later date via nipple tattooing.
The color chosen depends on patient preference and whether or not one is matching the opposite nipple.
Will insurance cover nipple reconstruction?
Insurance typically covers nipple reconstruction, as it is considered a reconstructive or medically necessary procedure.
Risks of Nipple Reconstruction
The standard surgical risks include pain; bleeding; infection; scarring; painful or hypertrophic scarring; hematoma; seroma; injury to vessels, nerves, surrounding structures; asymmetry; poor cosmetic result; contour irregularity; prolonged edema, numbness, parasthesias; fat necrosis; loss of projection; loss of part or all of the nipple and/or areola, need for further procedure and out of pocket costs; and risks of anesthesia.
Postoperative follow-up visits
Visits following surgery typically occur the day after surgery (for dressing change, evaluation, and reminder of instructions to avoid pressure on the nipple), the week after surgery, 2 weeks after that, and then spread out less frequently thereafter.
The schedule is adjusted based on doctor/patient preferences and needs.
What type of anesthesia is used?
Nipple reconstruction is typically done under local anesthesia with sedation, or light general anesthesia.
Some patients have little sensation in the area due to prior procedures, and opt for local anesthesia alone, without sedation.
The decision of which type of anesthesia will be make together depending on your health and needs.
Nipple reconstruction is a relatively quick procedure, and is performed as an outpatient.
The main precaution after surgery is to avoid pressure on the newly created nipple. Excess pressure can interfere with blood flow and healing, as well as lead to loss of desired projection.
You may shower 48 hours after surgery. No baths, soaking in tubs, hot tubs, or swimming pools until incisions are fully healed. Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incision is okay.
Scar gel may be used starting 2 weeks after surgery or once incisions have no open areas, crusting, or scabs.
You may drive once you are no longer taking pain medications, and allow a 24 hour minimum window between your last pain medication and driving.
All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient.