Nipple Reconstruction

Great question….. Let’s address the insurance portion first. If your health insurance covers mastectomy, it must cover reconstruction throughout all phases. There are some that do not have to abide by this rule, (WHCRA 1998) but they are few and far between. Some may limit the number of times you can undergo a procedure at their expense. The best way to assure they will pay for your procedure is to call the insurance company each time and make sure you have benefits available for the procedure you desire.

Nipple reconstructions can deteriorate over time. Those that seem a little too prominent at first tend to flatten out after a while and may no longer project enough to suit a patient. Tattoos fade, especially when applied to skin that has a large amount of scar. This being said, repeat nipple reconstructions are a quick procedure routinely performed with local anesthesia and it’s not unusual to require a touch up to your areolar tattoo.

James E. Craigie, M.D. Great question….. Let’s address the insurance portion first. If your health insurance covers mastectomy, it must cover reconstruction throughout all phases. There are some that do not have to abide by this rule, (WHCRA 1998) but they are few and far between. Some may limit the number of times you can undergo a procedure at their expense. The best way to assure they will pay for your procedure is to call the insurance company each time and make sure you have benefits available for the procedure you desire.

Nipple reconstructions can deteriorate over time. Those that seem a little too prominent at first tend to flatten out after a while and may no longer project enough to suit a patient. Tattoos fade, especially when applied to skin that has a large amount of scar. This being said, repeat nipple reconstructions are a quick procedure routinely performed with local anesthesia and it’s not unusual to require a touch up to your areolar tattoo.

James E. Craigie, M.D.

If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

Richard M. Kline Jr., M.D. If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

Richard M. Kline Jr., M.D.

Unfortunately, reconstructed nipples do not behave like natural nipples. They typically do not harden or soften with temperature changes or touch. Most reconstructed nipples also lack sensation. Unfortunately, reconstructed nipples do not behave like natural nipples. They typically do not harden or soften with temperature changes or touch. Most reconstructed nipples also lack sensation.

Thanks. How long did it taked for you to heal? When is the nipple rosy and back. Does it react like a normal nipple (HArdening and softening) or is it the same all the time? The nipple reconstruction was a piece of cake. It only took a local anesthetic and it was nice to able to walk into the OR instead of being wheeled in. I would have to go back and look up the exact procedure to get the details right, but my plastic surgeon used the star flap technique to create a nipple mound. No pain; all I felt was a little tugging.

I was able to go back to work the next day, and for the next three weeks or so he had me wear an eye patch (oval gauze pad they give you afer eye surgery) with a hole cut in the middle to cushion the fake nipple. After it healed I got the areola color tattooed in, which I was able to do over a lunch hour. I'm very pleased with the results. I know women who have skipped this step but I would have felt unfinished. I might have felt differently if I had a double mastectomy and had two scars, but I wanted to get some symmetry back. And it is a much better match with the other breast, the color is just about perfect. No one looking closely at it would mistake it for the real thing but the only people in that camp are my husband and me and we both think it looks pretty good. I'm very satisfied with my overall reconstruction. I'd consider it, especially if you had a single mastectomy.

The nipple reconstruction was a piece of cake. This was done with a local and I was actually able to walk into the OR. I would have to go back and look up the exact procedure to get the details right, but my plastic surgeon used the star flap technique to create a nipple mound. All I felt was a little tugging as he was suturing. I actually watched him do it. I looked up and could see what he was doing reflected in one of those overhead lights and commented on it. One of the nurses freaked out and said "We can move the light" and I said " I can also close my eyes" but I didn't because it was too interesting. Something I never would have imagined myself doing, but I guess that's what five surgeries in eight months can do for a person :) I couldn't resist making a joke when he finished, I waited a half a beat and said "I think you need to move it a little more to the left."

I was able to go back to work the next day, and for the next couple-three weeks he had me wear an eye patch (oval gauze pad they give you afer eye surgery) with a hole cut in the middle to cushion the fake nipple. After it healed I got the areola color tattooed in, which I was able to do over a lunch hour. I'm very pleased with the results. I know women who have skipped this step but I would have felt unfinished. It's a much better match with the other breast, the color in particular is just about perfect. No one looking closely at it would mistake it for the real thing but the only people in that camp are my husband and me and we both think it looks pretty good. I'm very satisfied with my overall reconstruction. The nipple reconstruction was a piece of cake. This was done with a local and I was actually able to walk into the OR. I would have to go back and look up the exact procedure to get the details right, but my plastic surgeon used the star flap technique to create a nipple mound. All I felt was a little tugging as he was suturing. I actually watched him do it. I looked up and could see what he was doing reflected in one of those overhead lights and commented on it. One of the nurses freaked out and said "We can move the light" and I said " I can also close my eyes" but I didn't because it was too interesting. Something I never would have imagined myself doing, but I guess that's what five surgeries in eight months can do for a person :) I couldn't resist making a joke when he finished, I waited a half a beat and said "I think you need to move it a little more to the left."

I was able to go back to work the next day, and for the next couple-three weeks he had me wear an eye patch (oval gauze pad they give you afer eye surgery) with a hole cut in the middle to cushion the fake nipple. After it healed I got the areola color tattooed in, which I was able to do over a lunch hour. I'm very pleased with the results. I know women who have skipped this step but I would have felt unfinished. It's a much better match with the other breast, the color in particular is just about perfect. No one looking closely at it would mistake it for the real thing but the only people in that camp are my husband and me and we both think it looks pretty good. I'm very satisfied with my overall reconstruction.

There are several ways to reconstruct a nipple. I prefer to rearrange tissue that is already in the area. The tissue (skin and a little fat) is lifted and twisted into a small cylinder to resemble the natural nipple. A couple of my patient's have described it as being "a bit like Origami"! The nipple and new areola are then tattooed at a later date to recreate the normal pigmentation.

Some surgeons prefer to use grafts from other parts of the body such as the labia, groin crease, or remaining nipple.

Dr C
http://www.PRMA-enhance.com There are several ways to reconstruct a nipple. I prefer to rearrange tissue that is already in the area. The tissue (skin and a little fat) is lifted and twisted into a small cylinder to resemble the natural nipple. A couple of my patient's have described it as being "a bit like Origami"! The nipple and new areola are then tattooed at a later date to recreate the normal pigmentation.

Some surgeons prefer to use grafts from other parts of the body such as the labia, groin crease, or remaining nipple.

Dr C
http://www.PRMA-enhance.com

While it is sometimes possible to reconstruct the nipples at the same time, usually for various reasons it is preferable to delay the nipple reconstruction until a later time. Nipples must be positioned very carefully to look their best, and that means the final shape of the breast mound must be stable prior to choosing the nipple position. Tissue flaps must be carefully monitored for several days following the initial reconstruction to assure early detection of any problems, and temporarily leaving extra flap skin on the breast mound helps greatly with this. Additionally, FWIW, the skin that the nipples are reconstructed from, whether flap skin or native breast skin, frequently has no sensation, making it even easier to reconstruct the nipples as a small procedure in the office.

Richard M. Kline Jr. M.D. While it is sometimes possible to reconstruct the nipples at the same time, usually for various reasons it is preferable to delay the nipple reconstruction until a later time. Nipples must be positioned very carefully to look their best, and that means the final shape of the breast mound must be stable prior to choosing the nipple position. Tissue flaps must be carefully monitored for several days following the initial reconstruction to assure early detection of any problems, and temporarily leaving extra flap skin on the breast mound helps greatly with this. Additionally, FWIW, the skin that the nipples are reconstructed from, whether flap skin or native breast skin, frequently has no sensation, making it even easier to reconstruct the nipples as a small procedure in the office.

Richard M. Kline Jr. M.D.

Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Richard M. Kline Jr., M.D. Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Richard M. Kline Jr., M.D.

i think this depends a lot on the plastic surgeon, but once the reconstruction is performed, it may be some months. the plastic surgeon would no doubt prefer that things heal and swelling come down and a final shape of the breast take place, before finding the best spot for a new nipple. i think this depends a lot on the plastic surgeon, but once the reconstruction is performed, it may be some months. the plastic surgeon would no doubt prefer that things heal and swelling come down and a final shape of the breast take place, before finding the best spot for a new nipple.