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| Nipple and Areola Reconstruction |  Even though the established goal of breast reconstruction is to make patients look natural in clothing, the majority of patients also want to appear as natural as possible naked. In spite of the technique used to perform breast reconstruction, nipple reconstruction reduces considerably to the illusion of a natural breast and is so well worth the effort. New techniques for nipple and areolar reconstruction provoke little or no pain and can be performed in the doctor’s office or clinic. The benefit in appearance is therefore attached at comparatively little cost or inconvenience.
Preceding techniques used to reconstruct the nipple and areola often relied on grafts received from the dark-pigmented skin between the leg and external female genitals. These procedures were not only painful but also expensive because they usually had to be performed in the hospital, making reconstruction of the nipple less desirable.
Nowadays, that technique is seldom used. In its place, the nipple is usually reconstructed with local flaps while the patient is under local anesthesia, and areolar reconstruction is accomplished with tattooing. For the reason that this method is so simple and typically painless, most patients decide to endure nipple reconstruction. As a rule nipple reconstruction takes place about eight to 12 weeks after breast reconstruction, and the tattooing is typically done about six weeks after nipple reconstruction.
The most significant attribute of nipple reconstruction is its position on the reconstructed breast. If located on the wrong part of the breast, even a perfectly shaped and colored nipple detracts from rather than adds to the illusion of a natural breast. Planning the right location for reconstruction of the nipple is therefore indispensable. That is why it is usually best to holdup nipple reconstruction until all other breast shaping, including any revision surgery, has been finished. Only then can the best location for the nipple be precisely selected.
Nipples are typically reconstructed using local flaps of skin and fat that are elevated from the breast mound to make a projecting nub. The flap donor sites are either closed by suturing the opposing skin edges together or, infrequently, by covering the donor site with a skin graft. Nipple reconstruction can be performed using either one larger flap or two smaller ones. Some surgeons prefer to use two smaller flaps since skin grafts are never necessary to close the wounds.
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