Purpose: To create a nipple to give the reconstructed breast a normal appearance
Length of operation: 30-45 min
Inpatient stay: Nil
Followup: 1 week
Time of work: couple of days
Recovery: 1 week
Risk: Infection, nipple shrinkage
This is a procedure to create a nipple and is done at the end of the reconstructive process. Creating a nipple at the top of the breast mound, gives the reconstructed breast a much better appearance.
Traditionally a nipple prosthesis has been used to replace the lost nipple, but it is artificial and frequently falls off. Other techniques involve removing a part of the normal nipple and then placing it at the site of the new nipple as a free graft. This has issues of graft take and loss of nipple sensation of the normal side.
The best current practice is to create a nipple from the available local tissues. Nipple reconstruction is normally done only after 3-6 months of breast reconstruction, which allows time for the reconstructed breast to settle down. It can also be usefully combined with breast lift procedure of the normal breast, to give better balance and symmetry to the chest.
The procedure involves local anaesthesia and is done as a day case, lasting typically for 30-45min. Dr Sanjay Azad will measure, mark and ensure that you are happy with the site of nipple placement.
The procedure involves raising a little piece of tissue as a flap. This flap of tissue is then is twisted on itself and sutured with dissolving stitches. The end result is a life like nipple, which is initially oversized to compensate for future shrinkage. A doughnut dressing is placed over the site of nipple reconstruction to protect the nipple from direct pressure.
The procedure is not painful, particularly so if nipple reconstruction has been done at the site of a previous flap based reconstruction. The dressing is changed after a week and then a bra is worn with a protective doughnut inside. This is again to avoid any direct pressure on the reconstruction. This status needs to be maintained for 3 weeks, when you can start wearing normal bras without any additional dressings. The stitches are all dissolving in nature and will occasionally work their way out. Gentle massage with moisturizing cream on the sides of the nipple reconstruction helps it to settle down in the longer term.
After 3 months of nipple reconstruction, the nipple and the surrounding area can be tattooed to replicate the pigmented area of the normal nipple (areola).
Complications are rare and include infection and bleeding. Scars settle down well and are effectively camouflaged by the tattooing process. Nipple shrinkage is common but not bothersome to most patients.