I am often asked about the process of nipple reconstruction after mastectomy at the time of breast reconstruction. I am grateful to Drs. Minas Chrysopoulo and Ramon Garza III of PRMA in San Antonio who took time to make the video. It can be viewed from this blog explaining the procedure.
My own experience during my DIEP flap breast reconstruction was a skin sparring, nipple sparring mastectomy. My breast surgeon clearly explained how she was going to make every attempt to save my nipples during my mastectomy. She also was very forthright in telling me, based on tumor size and location, she may not be able to save my nipples. I felt fortunate she successfully saved my nipples at the time of my double mastectomy.
This is not always the case for every woman or man who has a mastectomy. There are reasons nipples cannot be saved. There are also patients who choose to remove their nipples during their mastectomy, many times for peace of mind. I have spoken to women who make this choice. The conversation should be discussed with your breast surgeon or plastic surgeon at your consult as part of the shared decision-making process. These pre-planning appointments are important to the final aesthetic outcomes of reconstructing nipples after mastectomy.
I invite you to watch the video for more in depth discussion of nipple reconstruction after mastectomy. Here are some highlights from the discussion in the video.
- From a cosmetic standpoint, it’s always best if you can save the nipple, especially if you’re having implant-based reconstruction.
- Immediate reconstruction means the reconstruction starts at the same time as the mastectomy. It does not mean it finishes the same time.
- Usually, nipple reconstruction is performed at a second stage, or second surgery after the first phase of breast reconstruction.
- With a tissue reconstruction, such as DIEP flap using the tummy, the skin transferred as part of the breast is used to reconstruct the nipple.
- The skin is refashioned into a nipple and areola using various techniques, “a bit like origami” as Dr. C says. At PRMA they use a modification of the CV flap called a bow-tie method.
- The areola can be made using a skin graft from another part of the body or it can be tattooed after the nipple has healed and been reconstructed.
- PRMA uses tattooing and does not use skin graft to make the areola.
- The areola tattooing can be done by a qualified tattoo artist or by a nurse at your plastic surgeon’s office.
- The areola is either a 2D or 3D affect adding such details on the areola as the Montgomery glands, or little bumps seen on areolas.
- Dr. Garza explains the areola tattooing takes place approximately three months after the projection (nipple) is reconstructed. This allows healing to take place and the blood flow to become optimized, so the skin can accept the pigment better for the areola tattooing.
- Dr. C tells us no matter what type of reconstruction you have, whether implant-based or flap reconstruction you can have the nipple and areola rebuilt.
- With flap reconstruction, you use the new tissue that is transferred. With implant-based reconstruction, you use the existing tissue.
- Dr. C adds you don’t even need to have breast reconstruction to have a new nipple built. For example: If you decide to remain flat and just want a nipple, or if you are a male breast cancer patient who wants a nipple and there is tissue there, you can have a new nipple built.
I couldn’t help noticing Dr. C’s hands as he described the process of rebuilding the nipple in the video. In my humble opinion, they are the hands of an artist. The attention to detail both ASPS board certified plastic surgeons describe in this video give the viewer vocabulary and specific words to discuss with your own plastic surgeon. The nipple is very much a part of your breast and whether you choose to have it reconstructed after a mastectomy or not, the video gives you some valuable information.