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Reconstruction of the Nipple and the Areola Complex



Once a woman has gone through a double or a single mastectomy to remove cancerous tissue - the reconstruction typically consists of three different phases:

  • First Phase:  the breast mound is rebuilt

  • Second Phase:  the nipple/areola complex is formed

  • Third Phase:  Nipple tattooing or micro-pigmentation

Reconstruction of the actual nipple/areola complex is done in two phases and it is the final step in with breast reconstruction.  There are patients who are satisfied after their primary breast reconstruction and decide to forgo any further surgical procedures and not have a nipple made.  There is also the option where the patient can just elect to go for micro-pigmentation of the areola only.  This is where the areola is tattooed on to resemble the "areola portion".  For most patients, going through the final stage of having the nipple/areola complex reconstructed is the final touch on the newly created breast.

Although reconstruction with the use of breast implants is the least extensive of all breast reconstruction procedures, there are still some plastic surgeons that still prefer the reconstruction process with the flap technique. Although there are choices with how to achieve the end result of reconstruction, each woman should be assessed individually with their own preferences.

Breast cancer normally requires a timely treatment plan after diagnosis; however most women find that they have enough time to research treatment options and reconstructive advances before the actual breast cancer surgery. It is a very common fallacy that women have to wait a year or longer to begin the reconstructive process.

Having to undergo chemotherapy after mastectomy could delay reconstruction until the chemotherapy is completed. The majority of women elect to begin the reconstructive process soon after the actual breast cancer surgery, including some patients who elect to have this done at the same time as the mastectomy.






Most surgeons recommend waiting until the newly reconstructed breast is fully settled and healed in order to optimize the positioning of the nipple/areola complex.  This procedure is normally done anywhere from three to six months post operative after the primary reconstruction. This is done as an outpatient procedure at either a surgeon's accredited surgical suite, outpatient surgery center, or day surgery at a hospital.

Nipple reconstruction can take anywhere from one to two hours to complete, however; the times might be different based on the method that is chosen.  Nipple reconstruction is a permanent procedure, however; the areola which has been treated with a tattoo might fade out a little bit with time.  This part of the procedure can easily be touched up at any time.  Nipple and areola reconstruction can be done right in the plastic surgeon's office using local anesthesia and sedation.








The nipple mound is normally skin that is taken from a flap on the new reconstructed breast.  The graft technique involves harvesting skin from a donor site separate from the reconstructed breast.  The areola is done with micropigmentation or a tattoo or can be reconstructed from another skin graft located on the body.

If the patient has had only a single mastectomy, the surgeon has to evaluate the coloration, skin texture, size, shape and the location on the breast mound where the reconstructed nipple/areola complex will best match the other side. 

With a patient that has gone through a bilateral mastectomy, using local tissue flaps on both sides is a good surgery option since both nipples will look similar.




The flap technique include:






                 2010 Copyright MDAnderson Cancer Centre - University of Texas - Used with permission











                                     Copyright 2010 ADAM, Inc. - Used with permission


                            Star Flap Technique - Nipple Reconstruction Surgery










                             Copyright 2010 St Marks Breast Centre - Used with permission












Donor sites for these grafts include:

  • the inner thigh

  • behind the ear

  • reconstructed breast

  • abdominal scar from a TRAM Flap procedure

  • labia (the skin folds of the vulva - just outside the vagina)






Tattooing or micropigmentation of the nipple/areola complex after breast reconstruction can give the newly reconstructed nipple a very natural appearance. This part of the nipple reconstruction phase is done under a local anesthetic and usually only takes approximately 30 to 40 minutes.  Reconstructed nipple and areola have very little sensation. 

Using an electric needle that pulsate 150 times per second, the micropigmentation artist (which can be either a surgeon, nurse, aesthetician or an independent tattoo artist) - carefully mixes the pigment dye to match the pink, brown, or coral coloration of the woman's remaining nipple, lips, or a pre-operative photo of their original nipples. 

As with all tattoos, if there is scar tissue, the pigment has a harder time taking in these areas.  In order to make these areas accept the pigment or dye - microdermabrasion or laser treatments might be suggested for the scar areas. 





                                             2010 Copyright CosmeticSurgeryForums.com


       Patient at Part One of a Two Part

        Nipple/Areola Reconstruction

         Three Days Post Operative






After having your session with the micropigmentation artist for your new areola you will need to keep Bacitracin (Antibiotic Ointment) or Aquaphor and a gauze dressing placed inside your bra or tape to your newly reconstructed breast. 

The color of the pigmentation of the tattoo will appear much darker at first. Micropigmentation is done darker as you end up losing 40% of the pigmentation as you heal and exfoliate.  The blood and some of the ink will exfoliate off over the next several days. It is during this time of exfoliation that the true color of the tattoo will be shown.  Keeping the area moisturized with the ointment is important.  Healing of the tattoo will be faster if you can let the area "air dry" for a period of time each day.

If you find the tattoo has gotten too light during your recovery, having another session to have more pigment added is very common.  Your tattoo will last longer if it isn't exposed to UV Light or sun-light.





                                             Licensed image for CosmeticSurgeryForums.com


                                                 Micro-pigmentation to the Areola








  • Comparison of the Nipple/Areola Reconstruction and Micropigmentation

Another option for nipple/areola reconstruction is to use a graft of skin from another location of the body, usually your inner thigh or waist. Skin from these areas of the body has a natural tendency to heal darker when it is grafted. Areola grafts are performed in the operating room. 








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