Nipple and Areolar Reconstruction

Summary

The goal of nipple reconstruction is to make the reconstructed breast appear more normal and symmetric. Nipple and areolar reconstruction significantly improve the quality of the reconstructed breast and should be encouraged by the surgeon. To that end, it should be kept as simple, convenient, and inexpensive as possible. The most important step in nipple reconstruction is proper location. The location of the nipple should be determined only after breast mound shaping has been completed and is more likely to be correct if the mounds have been made symmetric.

There are many nipple reconstruction methods currently available. Of the standard techniques, we have found that the modified double-opposing tab flap gives the best long-term projection, possibly because the MDOT flaps have a better blood supply (for an equivalent amount of flap tissue) than nipple reconstruction techniques that rely on only a single flap. Nevertheless, many currently available techniques can be successful. If the breast mound needs reduction, however, both breast shape and projection of the nipple/areolar complex can often be improved by using the wrap-around flap technique. Areolar reconstruction and pigmentation of the nipple are best accomplished with tattooing, usually performed approximately 4 weeks after the nipple reconstruction has been completed.