Nipple and areola complex reconstruction is begun some months after the breast mound swelling has diminished and the shape of the breast has settled in. Premature placement of the nipple and areola will cause it to be either too high or too low.

Under either general or local anesthetic, the new nipple is outlined on the peak of the breast mound. Using tissues from this area, the nipple is raised and fashioned. A skin graft is then taken from the upper, inner part of the thigh to form the surrounding doughnut, or areola, leaving behind a fairly inconspicuous thigh scar. The operation is usually performed on an out-patient basis and is accompanied by some tenderness in the thigh donor site for a week or two.

The shape and projection of the new nipple and size of the areola are approximated to that of the opposite breast. However, the color of these structures may not be identical to the original. When this is a problem, tattooing of both the nipple and areola may produce more acceptable results. Sometimes simply tattooing the shape of a nipple and areola on the mound will give the illusion of having a completed reconstruction, although authentic projection is lacking. Alternatively, the nipple is rebuilt and the surrounding areola is tattooed without the use of a skin graft.

A less frequently used method is taking part of the nipple from the opposite breast to fashion a nipple for the new breast. However, the other nipple may be too small to be used, and there is a risk that sensation in the existing nipple will be diminished.

The nipple from the original breast containing the tumor can rarely be used on the reconstructed breast. There is concern that some cancer cells will be transferred to the newly formed breast. Besides, with the available technology, nipple and areola formation has been elevated to a refined art.

Often, two operations can be combined so that the nipple and areola are fashioned simultaneously with the remolding of the opposite breast. The newly fashioned nipple and areola transforms the reconstructed breast to appear more like the original. Unfortunately, though, the new nipple and areola will not have the original nipple’s unique sensitivities.

Sometimes a false nipple can be used. These are made of soft plastic and simply adhere to the peak of the new breast. The false nipple will give an authentic projection under your clothes but, again, will not have the original nipple’s sensitivity nor will it be a permanent part of the breast.

Nipple and areola formation is usually regarded as the final step which completes the reconstruction. Many women see this step as an ending to the struggles, physically and psychologically, which began with the initial diagnosis of breast cancer.

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Roses Grown and Photographed By Dr. Jeffrey Rosenthal