NIPPLE AND AREOLA

Can the nipple be preserved?

Preserving the nipple is an option in cases of preventive mastectomies or a small, early-stage breast cancer located near the outer part of the breast.

Using nipple-sparing mastectomy the breast tissue is removed, but the overlying breast skin and nipple are left in place. The surgeon often removes the breast tissue beneath the nipple (and areola) during the procedure to check for cancer cells. If cancer is found in this tissue, the nipple must be removed. It is more often an option for women who undergo a preventive mastectomy or a small, early-stage cancer near the outer part of the breast, with no signs of disease in the skin or near the nipple. Cancer cells are more likely to be hidden in the nipple if the breast tumour is more extensive or close to the nipple. This means there is a higher risk cancer will come back if the nipple is sparred. Afterward, the nipple may not have a good blood supply, causing the tissue to shrink or become deformed. Because the nerves are also cut, there often may be little or no feeling left in the nipple. For women with larger breasts, the nipple may look out of place after the breast is reconstructed. As a result, this surgery is best done in women with small to medium sized breasts. The main advantage is that this procedure leaves less visible scars and offers an aesthetically much better result than nipple-areola reconstruction. Your options must be discussed with a breast cancer surgeon.

How is the nipple reconstructed?

The nipple is typically made from the patient’s own breast skin using local anesthesia in an outpatient setting.

The procedure is usually done at least 12 weeks after the reconstruction of the breast mound, once the wounds are fully healed and surrounding tissues adapted to the reconstructed breast.

Two pieces of skin and fat shaped like a “V” are surgically raised up, wrapped around and sutured to make a projecting nipple. All of these pieces of skin remain attached to the body to maintain blood flow and keep the flaps of skin alive. The newly formed nipple is held in place with sutures, and a bulky gauze dressing is placed over to protect it for about 2 to 3 weeks. Other options to fill the nipple with cartilage, the patient’s own fat, or an injectable filler also exist. After the reconstruction, the nipple remains mostly numb since it lacks nerve endings to transmit sensation. The reconstructed nipple significantly flattens after scars heal, mature and distend in a couple of months. It is not unusual that their projections disappear entirely. Therefore a revision surgery is needed. 

How is the areola reconstructed?

The areola is usually reconstructed 8 -12 weeks after nipple reconstruction with a medical tattoo.

Over time the colour intensity of a medical tattoo slowly fades, and it can happen that the procedure would have to be repeated after a year or so. Less commonly areola can be reconstructed at the same time as nipple with grafted skin from the labia or pigmented inner groin skin.