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Secondary Operations -
Nipple Reconstruction
This is a minor operation that can be done either at the time of initial surgery or more commonly as a delayed procedure. Not all patients elect to have this done and as with all aspects of breast reconstruction is an option on which the patient can decide. However, it does give the reconstruction a lot of realism and can also help with symmetry if the opposite nipple is obvious through clothes.
Although done in most centres as a delayed operation I prefer to do it at the same time in most cases of primary (immediate) reconstruction. I always do it as a delayed operation in secondary (delayed) reconstruction. The main difference lies in the ability to predict where the nipple should be situated upon the reconstructed breast. When a mastectomy is done through the nipple leaving only the nipple defect it is easy to predict the correct position and immediate nipple reconstruction is performed. In all other cases where a paddle of skin is placed on the breast it is better to wait for this to settle and do reconstruction as a delayed procedure in the correct position.
There are different methods of performing reconstruction. Two main methods are either by lifting small skin flaps and wrapping them around themselves (see diagram) or by taking a part of the opposite nipple and grafting to the reconstructed breast (Nipple Share Procedure). My preference is to reconstruct the nipple (the projecting part) and use tattoo for the aereolar (pigmented disc) later. The operation can be done without anaesthetic and as a day case.
Click here to see a diagram showing how the nipple is made
Prosthetic nipples
The other option to surgery is to have a rubber moulded nipple made. These are highly realistic and moulded on the opposite side. They look more realistic than surgically made ones but suffer from the disadvantage of needing to be stuck on.
Operation facts
- Average length of stay - Day case
- Average length of surgery - 30 minutes
- Time restricted to bed - Nil
- Bladder catheter used - No
- Time to walking - Same day
- Walking easily - Same day
- Time to exercise - 2 weeks
- Time to full recovery - 0-2 weeks
- Time off work - 3 months
- Dressings - Breast
- How long for dressings - 2 weeks
- Bras and garments - Nipple dressing for 3 weeks
- Potential donor site problems - Nil
- Potential reconstruction problems - ~2% - Total failure, part failure
