Once you have undergone implant reconstruction, you are at liberty to either go for or not go for nipple reconstruction. The choice is all yours. Many women whose nipples are removed after mastectomy usually opt to undergo the surgery.
This procedure is normally done after the breast has had sufficient time to heal, preferably after 3 to 4 months of breast reconstruction surgery. You may add yourself more time if you wish.
The nipple reconstruction surgery does not require you to be in the hospital overnight. It is essentially an outpatient surgery. We provide all our patients with the preparatory steps to take prior to the D-Day. We also advise that you make arrangements for someone to drive you home after the procedure.
Some key points to remember about the nipple reconstruction surgery include:
•There are different techniques that can be used for this reconstruction surgery. These include skin graft, skin flap, medical tattooing and autologous graft
•The amount of time taken could be anything from 30 minutes to more than an hour depending on the chosen method
•The number of complications is minimal, but the highest rate of complications is witnessed with skin grafts
The following is a deeper look into the nipple reconstruction techniques:
This method involves reconstructing the nipple from surrounding skin at the desired nipple site.
It begins with the surgeon making several marks and then elevating the tissue into position to form and shape it into a living tissue projection that resembles the natural nipple. As time goes by, older techniques such as using donor genital tissues are fading away.
Tattooing can be done on the new nipple to add color and the areola around it. Adopting three-dimensional color shading tends to produce the best physical and visual results.
Most surgeons adopt the dermabrasion technique that pushes the pigment into the skin through high-frequency vibrations. However, not so many colors are available for this technique and dermabrasion tattoos may diminish with time.
Additional fat, skin or synthetic fillers may be used to help the nipple obtain a more erect outlook.
In case the chosen area for a new nipple does not have enough skin for the procedure, skin grafts may be used. The skin grafts are normally obtained from the groin, the creases of the buttocks, thigh, and abdomen or where the legs and torso meet.
But this less common as a result of the many complications associated with it.
This is a widely adopted technique when there is the need to recreate a nipple with a natural feeling. Skin grafts (discussed below) can be used to compliment the tattoo procedure.
A tattoo is suitable for women who no longer want to go through more surgeries. One thing to note is that the nipple in this case will not be elevated.
Plastic surgeons are well versed with tattooing, but majority of them acknowledge that professional tattoo artists make use of three-dimensional techniques to produce a lifelike nipple.
Since the reconstructed breast lacks the same sensation it had earlier on, the tattoo may not be much painful.
The elements used are usually ones that can match your other nipple. The pigments may however fade as time goes by, creating the need for a tattoo touch up.
Tattoos not performed by medical practitioners are not normally covered by insurance firms.
Besides tattoos providing you with a nipple-appearance on your breast without undergoing any surgery, there are some few other options that can be used to achieve the same results. Polyurethane nipples are probably the most common ‘fake nipples’. They feature a semi-erect position and their texture and color is much closer to the natural nipple. They are normally attached by moistening the back and sticking them on the breast, much like a suction cup. These can be worn and removed in any way you want.
Local anesthesia is normally used to conduct nipple reconstruction. In this case, a needle is used to inject and numb the target area. The implication is that you will be awake throughout the procedure.
The most favored approach is skin flap, which we also use at our center. However, there are cases when we will have to extract skin from labia or inner thigh and graft it on the breast for nipple formation. The opposite breast is also a potential source. Be keen to understand the reconstruction process, especially if we recommend graft. The area on which the skin is obtained is also numbed using local anesthetic.
In case general anesthetic is found to be more appropriate, an intravenous infusion (IV) is inserted into your arm through which you receive relaxing medication.
Any of the methods described above can be used once you have been prepared for the surgery. Flap skin method is the most basic and the nipple area can be tattooed after about three months.
If the graft method is used, an incision will be made at the area in which the skin is obtained. Once again, ensure that clarity is made whether this is a necessity or not and if so, ask for convincing reasons.
The reconstructed nipple can be reinforced with some skin substitute to ensure it doesn’t flatten out too much. This is not a compulsory requirement because a small amount of your fat or scar tissue can achieve the same results.
After the nipple has been sewn into place, it will be protected using a nipple shield filled with an antibacterial ointment.
Time taken for the entire process could be anything from 30 minutes to more than an hour. This depends on the technique used.
As already stated above, nipple reconstruction is an outpatient procedure. Those who had local anesthesia will be free to go home once the shield is in place.
The patient who received general anesthesia will first be taken to a recovery room. Upon waking up, your blood pressure, body temperature and heart rate will be checked before you are allowed to go home. Arrangements must have been made earlier on for someone to drive you home.
You will be given specific recovery instructions.
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