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The unavoidable removal of one or both breasts due to a breast cancer diagnosis is a tremendous physical as well as emotional effort. Rebuilding the breast can greatly benefit the psychological healing process, general well-being and acceptance of the physical changes. The reconstruction of the nipple, in addition to a previous breast reconstruction, represents the aesthetic finishing touch. Similar to a work of art, a final and decisive brushstroke is applied after the somewhat more invasive basic construction. The nipple should not be carried out in the primary breast reconstruction operation, as there can still be significant changes in shape in the first few months after the operation and the final result can ultimately only be judged well after this time.
This applies both to reconstruction with implants and to reconstruction with the patient’s own body tissue. In the further development, the change in the tissue contours of the breast, as well as the subsidence process and especially the decrease in volume are noticeable. Especially in the case of flap plastic surgery involving the musculature, such as the use of the latissimus dorsi muscle, the DIEP flap, (a relatively new method of breast reconstruction with the patient’s own tissue without the use of or damage to musculature or other methods), it is always a challenge to reconstruct a beautiful and pleasantly fitting breast for the patient concerned.
The most proven surgical methods for reconstructing the nipples by local flap-plastic, i.e. tissue shifting on the reconstructed breast, are mentioned below:
S-flap: A tissue mobilisation based on the letter “S” as a version of a local flap-plastic, enables reconstruction.
Skate Flap: Here a new nipple (“papilla”) is formed from the existing tissue of the breast by small flap plastic surgery. The areola is reconstructed by means of a skin graft (e.g. from the inner thigh). The donor site on the thigh is primarily sutured.
Labia graft: The graft from the labia minora is used as a papilla (nipple), the areola is also reconstructed from skin from the thigh in this method.
C-V Flap: A very beautiful method of modelling the papilla. Here a flap sculpture is formed, similar to the shape of a maple leaf. This method is very safe, even with difficult previous operations. It is a short procedure with a healing phase of about two weeks. Afterwards, a very beautiful, natural-looking nipple can be reconstructed; either by tattooing, or even more beautifully, by transplanting skin from the intimate area.
Tattooing: If a method of nipple reconstruction as described above is used, then the result can be made more precise by tattooing or by means of permanent make-up by our team of specialists. Although colour matching of both nipples is difficult, very natural and accurate shades of the areola with papilla can be achieved. The tattooing can be performed painlessly under local anaesthesia.
Before the operation, patients determine the position of the new nipple in front of a mirror. The nipple is built up by moving small areas of skin on the spot. A variety of techniques can be used to form a new nipple from the existing tissue. The nipple is initially made much larger, as its size decreases by up to 50 % as the healing process continues.
Risks and possible complications:
The most frequent shortcoming in the formation of a new nipple is that it is created too small. Therefore, immediately after the correction, the nipple must be visibly larger than the nipple on the opposite side. Another risk is the loss of skin due to insufficient blood supply and therefore possibly the loss of the new nipple.
Aftercare:
Immediately after the operation you will be given an appropriate bandage to protect the nipple. This must be worn continuously for at least one week. No other special aftercare techniques are necessary.
Reconstruction of the nipple using nipple tissue from the opposite side. Our alternative technique:
If there is still one breast with a nipple, tissue can be taken from the opposite nipple. If the opposite nipple is large enough, it is possible to remove the lower half to form the new nipple. Here, as in a skin graft, tissue is transplanted and this constitutes the new nipple. In a second procedure, a skin graft completes the reproduction of the areola.
As this is the most natural form of reconstruction, it is our favoured procedure.
Risks and possible complications:
The main risk is loss of the new nipple due to inadequate blood supply. Very rarely, a limited feeling of touch of the healthy nipple occurs, which can remain at least for a certain time, but also permanently.
Aftercare:
Immediately after the operation, an appropriate bandage is applied to protect the nipple. This must be left on continuously for at least a week. No other special aftercare techniques are necessary.
Reconstruction of the areola with skin from the groin. Our surgical technique:
Skin from the groin can be used to build up the areola, as the groin and nipple match each other perfectly in colour. Only a short, line-shaped scar remains on the groin. The skin graft is placed around the nipple, which is formed in the same session, and fixed with a bandage. After about a week, the skin is completely healed.
Risks and possible complications:
The new skin often darkens, but this does not significantly affect the optical result. Rare risks are the loss of skin. In these cases, the operation must be performed again or, alternatively, an areola must be tattooed.
Aftercare:
After one week, the pressure bandage is removed; no special aftercare is necessary.
Reconstruction of the areola by tattooing:
This is not a surgical reconstruction of the areola. We recommend that the tattooing be carried out by an appropriately trained beautician. It is a relatively uncomplicated procedure for experienced professionals, although several sessions are usually important for finding the perfect skin tone.
