For the majority of patients undergoing a mastectomy the areola and nipple are removed, unless a special nipple-sparing mastectomy is requested. Therefore some may opt for nipple reconstruction after mastectomy, typically after mound reconstruction has taken place to make it appear as its original form.
The Procedure/ Surgeries
After the reconstructed breast mound heals which usually takes about 3 to 4 months after the surgery, the nipple reconstruction and areola tattooing are considered. They are the final and optional phases of breast reconstruction.
Reconstruction surgery itself involves the use of the patients own tissue (Known as autologous surgery, as opposed to implants which are not viable for nipple reconstruction). There are also other lighter and less permanent non-surgery options such as prosthetic nipples or areola tattooing (tattooing on an areola for aesthetic purposes) should this surgery not be possible or fail in a rare event. The patient should be aware that although they will expect to regain a fully erect nipple, they will lose not regain sensation.
Autologous Nipple Reconstruction
There are several methods of autologous nipple reconstruction after a mastectomy;
Skin Grafts are one such method
Doctors can take skin grafts from a number of potential areas for nipple reconstruction. This can be the breast area, the back or inner thighs, the crease of the buttocks, the lower abdomen. It is most common to take the tissue from around the breast area. All of these tissues can be used to create a healthy-appearing nipple on the breast.
Skin Flaps are another method
The Skin from the reconstructed breast can be folded and sutured together to build a new mound that will become the nipple. The skin is manipulated to give an elevated appearance; Addition skin, fat, or synthetic fillers can be used to make the nipple more erect.
Autologous graft “Nipple Sharing”
This option is only possible if there is an unaffected breast which is large enough to share a portion of skin, It can be shared for re-creating a new nipple.
In rare cases with autologous nipple reconstruction after mastectomy, the tissue used may not get enough blood flow and result in some tissue death. In this case, the dead tissue would be trimmed and the nipple reconstructed again.
Another rare event, the reconstructed nipple could flatten out and in this case, the nipple would have to be reconstructed and reinforced with a graft of scar tissue, fat or dermal material to prevent it happening again.
In summation, nipple reconstruction after a mastectomy is a valid choice and is, in general, a low-risk surgery for a high-reward, i.e your self-confidence returning, psychological health and feeling normal again. It is often covered by insurance or free medical cover. Ask your doctor about anything you have concerns about, and be sure to follow any and all preparations and post-surgery advice he asks you to follow if you decide to go down this route.