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Creating the nipple areola is the final component to making your breast reconstruction complete. There have been numerous approaches to nipple reconstruction over the last 30 years, and with several options available, surgeons can utilize whichever method is most suitable for their patients. There is no one absolute best method of nipple reconstruction for all patients. Some patients are comfortable without having a nipple, and do not wish to have further surgery. Others choose the non-surgical option of tattooing without reconstruction. This allows color pigmentation to simulate the nipple areola without the contour of an actual nipple. Still, the reconstruction of the nipple areola helps to put the finishing touches on the new breast after a long journey in reconstruction.

After optimal symmetry between the breasts has been achieved, the nipple areola reconstruction can be done. There are a number of factors that help determine which method of nipple reconstruction is right for you. These include the quality of tissue on the reconstructed breast, and whether you are having nipple reconstruction with or without a surrounding graft. Even more important, is your surgeon’s preference.

Historically, one technique included sharing a piece of the nipple from the opposite breast. This surgery is not used today, because it transfers breast tissue to the reconstruction that could potentially form a new cancer. Another method used in the past involved taking a full thickness skin graft from the labia to create a dark colored areola. This outdated technique leaves a scar in an undesirable location. Also, these grafts may be hair bearing, and areolar pigment is easier achieved with medical tattooing.

In modern approaches to nipple reconstruction, the nipple mound is created from skin taken as a local flap on the reconstructed breast. Various local flaps have been described, including the Skate flap, the C-V flap and the Star flap. Regardless of which approach your surgeon chooses, the outcome will be a nipple mound. The areola can then be either tattooed, or it can be reconstructed with a skin graft taken from elsewhere on the body. Common donor sites for the graft include the abdominal scar from a flap reconstruction, the inner thigh, or the buttock crease.

Nipple Reconstruction Procedures