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Post-mastectomy reconstruction can restore the shape, volume, and profile of one or both breasts; however, unless the patient has undergone nipple-sparing mastectomy, the reconstructed breast will be missing the nipple and areola. While some women may be satisfied simply to have the breast itself reconstructed, many desire the more natural appearance that can be provided by the addition of a nipple areola reconstruction. Our plastic surgeons are specialists in breast reconstruction and can choose the method of nipple areola reconstruction that will be most effective at producing the desired results.

The Nipple Areola Reconstruction Procedure

Modern nipple areola reconstruction procedures typically involve creating and using local skin flaps that are elevated directly from skin on the reconstructed breast. In the past, nipple areola reconstruction techniques included taking tissue from the opposite breast and nipple or using skin grafts from the labia or groin. Our surgeons do not favor these older techniques since nipple sharing procedures from the other breast risk moving breast tissue from one side to the other and using labial or groin tissue for a graft may generate hair growth on the new nipple while potentially resulting in undesirable scarring at the donor site. 

Today, the type of local skin flap that is used for nipple reconstruction will be decided by your surgeon – examples of the various techniques include the skate flap, C-V flap, and star flap. The local skin flaps elevated are used to create the nipple mound, which produces the contour and texture of the nipple. Once the flaps have been created through small incisions and the nipple mound has been reconstructed, the incisions will be closed and left to heal.

Over time, as a natural part of the healing process, the nipple will lose some of its projection. If the nipple projection requires correction because it has lost too much elevation, it may be possible to revise the nipple reconstruction through the use of dermal fat grafts, as well as dermal fillers such as Radiesse®. It may also be possible to use an acellular dermal matrix, such as AlloDerm®, at the time of nipple areola reconstruction or at a later date, to help maximize nipple projection. Alternatively, additional secondary skin flap elevation may allow improved nipple contour.

To complete the appearance of the areola, a skin graft can be used or, in most cases, nipple areola tattooing can be done after the nipple reconstruction has healed.  If a skin graft is used for the areola, the graft can frequently be taken from the skin adjacent to healed scars elsewhere on the body. For example, in patients who have had a DIEP flap breast reconstruction, a skin graft may be taken from the skin of the lower abdomen where there is already a healed scar. Grafting of the areola is typically done simultaneous with the skin flap nipple reconstruction, although the skin graft can also be done at a second stage. Whether or not a skin graft is used for the areola, a tattooing procedure will complete the reconstruction by providing a more natural color to the nipple and areola. Tattooing of the nipple areola is done as an office procedure once all of the scars have healed.