Nipple and Areola Complex (NAC) reconstruction is often the final stage of breast reconstruction. It is usually done three to six months after breast reconstruction to allow for the reconstruction to settle and assume its final contour before the nipple and areola are recreated.
The reconstructed nipple will not have sensation, nor will it become erect with cold or touch, but it completes the reconstruction and for many ladies is the icing on the cake that acts as the finishing touch and makes the reconstruction appear truly natural.
The nipple can be reconstructed with either a local flap or a nipple-sharing procedure.
Local Flap Reconstruction
Local flap refers to small area of skin and subcutaneous fat of the reconstructed breast that is elevated and folded into a three dimensional shape. It is a little like origami. Thee flaps are sutured into place to create a prominence. The procedure is done under local anaesthetic and takes approximately 20 minutes.
Following the procedure you will have a light dressing for one week and an additional ring like pad to wear in your bra for 6 weeks.
Risks of any minor operation include infection, bleeding, abnormal scars and skin necrosis. Additionally nipple reconstructions do have a tendency to flatten over time and therefore I usually make them too big initially in the knowledge that they will flatten out over the coming months.
Once the scars have healed the nipple and surrounding area can be tattooed to add the colour for the final effect. I can recommend a practitioner to do this for you.
Nipple Sharing Procedure
Some ladies have very large nipples that will be impossible to match with a flap reconstruction. In these cases I will discuss nipple sharing with you. In this procedure a small piece from one nipple can be moved as a free nipple graft to reconstruct the nipple on the other breast.
The donor nipple becomes slightly smaller offering the opportunity to have symmetrical nipple reconstruction. Sensation and function should remain intact for the donor nipple although is occasionally reduced. Other risks of this operation include infection, bleeding, abnormal scars and graft failure.
Once the scars have healed the surrounding area (areola) can be tattooed to add the colour for the final effect. I can recommend a practitioner to do this for you.