Introduction:
Females who lose nipples or areola due to surgical excision, cancer, trauma, or other reasons remain distressed even after breast reconstruction. Nipple areola reconstruction surgery is a boon for such females. Other conditions that require nipple-areola complex reconstruction include burn deformities, congenital pathologies, and complications due to breast cancer surgeries. The most significant advantage of nipple-areola complex reconstruction is that it can be performed along with different reconstructive surgeries or after their completion. Though the surgery is the simplest from a technical perspective, it is of great value from an aesthetic perspective. Studies report that patients are extremely satisfied with surgical outcomes.
What Is Nipple-Areola Complex Reconstruction?
The advent of nipple areola reconstruction surgery dates back to the 1940s. It emerged in conjunction with breast reconstruction surgeries from the time of breast cancer treatment. As the name suggests, the surgery comprises techniques wherein the nipple and areola are reconstructed. This reconstruction helps correct the position, anatomy, shape, size, and texture of the nipple and areola. Several innovative techniques are available for the same, wherein flaps are obtained from different body sites and implanted at the required area. Skin grafting and tattooing are the most common techniques of areolar reconstruction. With the advent of newer methods and technologies, the number of side effects or complications has possibly reduced.
What Are the General Principles of Nipple-Areola Complex Reconstruction?
Normally, nipple areola reconstruction is performed as an outpatient procedure under local anesthesia. However, the below-mentioned guidelines must be followed while planning for nipple-areola complex reconstruction:
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The surgery's timing is crucial, implying that the procedure is postponed until the breast reconstruction procedures are not complete. The surgery is usually done three to four months after breast reconstruction. Doctors usually give special importance to the surgery timing because early decisions can result in the improper placement of nipples. A three to five months gap allows the swelling and inflammation associated with breast reconstruction surgeries to subside.
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For people willing to undergo unilateral reconstruction, the contralateral nipple or areola serves as a template.
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In the case of bilateral reconstruction, the surgeon uses standard values to determine the size, shape, and position of the nipple and areola.
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It is essential to examine the area after breast reconstruction. This is because the choice of flaps depends on the patient's subcutaneous tissue base.
How Should the Patient Prepare for Nipple Areola Reconstruction Surgery?
Nipple areola reconstruction is usually done at the doctor's office, and the patient is discharged on the same day. The patient will be administered local anesthesia before the reconstructive surgery. However, the patient can consult the surgeon to know more about the type of anesthesia that will be administered. The doctor might instruct the following before the procedure:
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Avoid drinking or eating for a specific amount of time before the surgery.
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Do not consume any drugs on the day of surgery.
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The patient must wash the area with an antibacterial soap the night before the surgery.
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Do not use lotions, scented products, or deodorants before or after the surgery.
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Always wear comfortable, loose-fitting cotton clothes before the surgery.
What Are the Different Types of Nipple Areola Reconstruction Surgeries?
Several types of surgeries can be done for nipple and areola reconstruction. However, the exact type depends on the breast size and location of cancer. As a result, some patients can opt for nipple-sparing surgeries also. People who have a total mastectomy become candidates for nipple areola reconstruction surgeries. During the procedure, the doctor obtains skin from the breast or other body parts to reconstruct the top part of the nipple or areola. In addition, doctors also try to construct a new nipple to match the position, size, and shape of the original one. Though different types of surgeries can be done, the doctor will always consider the patient's personal choice. The different types of nipple reconstruction surgeries are described below:
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Skin Flap Reconstruction - It is a procedure wherein the doctor takes skin tissues from different sites. Next, the surgeon folds and stitches the skin flaps together above the level of nearby skin. As a result, a bump is formed, which resembles a new nipple. Studies report that the nipple formed after skin flap reconstruction surgery might flatten over time. Though the procedure is harmless, the patient might need additional surgeries to resolve the issues.
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Skin Graft Reconstruction - It is a procedure wherein the doctor obtains a small piece of skin from a particular site, including the buttocks, stomach, or inner thighs, to create a new areola. However, this procedure would only be successful when there is insufficient tissue on the breast mound. Studies report that the skin graft procedure provides an ideal match related to the color and texture of the nipple and areola.
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Medical Tattooing - Some patients tend to get a medical tattoo over the reconstructed nipple to appear natural. In addition, one can skip reconstructive surgeries and get a medical tattoo. Normally, tattooing is done by surgeons or medical staff. However, some people tend to get tattooing done by skilled tattoo artists because they use three-dimensional techniques to enhance their appearance. During the procedure, pigments are selected to match the nipple. Over time the pigments might fade; hence, one needs to get the tattoo touched up frequently.
How Does the Recovery Occur After the Nipple Areola Reconstruction Surgery?
During the healing, the patient might experience tenderness and pain in the nipples. Initially, the nipples might appear pointed, but they flatten out later. People who have undergone skin graft surgery usually require a nipple protector. The nipple protector and other stitches will be removed a week after the surgery. The surgeon might recommend the patient continue wearing the bra bandages for a few days after the surgery. They will be removed only after the post-surgical examination. People who have undergone medical tattooing tend to experience crusting or flakiness. In addition, the patient might be recommended to use an antibacterial ointment to clean the area. Avoid using harsh soaps or scrubs until the healing is complete.
Conclusion:
Nipple areola reconstruction is a complex procedure that can be done in several ways. Patients prefer it after a breast reconstruction surgery to improve the appearance of the nipple and areola. However, the patient must consult a plastic surgeon to know more about the ideal surgery methods and their risks or complications.
