The Nipple Areolar Complex and Breast Reconstruction
The final stage of breast reconstruction is the reconstruction of the nipple-areolar complex (NAC). Usually, this is performed after the nipple reconstruction, however, it may be done without it as well. While some women do not want to have anything further done after the breast has been reconstructed, these often in-office procedures are simple and easy to perform, and are “the finishing touches” of the completed breast reconstruction. Women who have the NAC reconstructed reiterate the fact that just having the semblance of a nipple when looking in the mirror or getting out of the shower has made a dramatic impact for having a finished breast and the constant reminder of her previous cancer.
I usually like to create a nipple first if one decides to proceed with the NAC reconstruction. This provides the projection of an actual nipple and can mimic the appearance of the nipple. If one foregoes this procedure and only have the impression of a NAC recreated, options for such are skin grafts and tattoos.
I usually like to create a nipple first if one decides to proceed with the NAC reconstruction. This provides the projection of an actual nipple and can mimic the appearance of the nipple. If one foregoes this procedure and only have the impression of a NAC recreated, options for such are skin grafts and tattoos.
Skin grafts are usually taken from the medial thigh or groin area, as the skin is typically darker in color and the donor site incision is concealed. The skin graft recreates a very similar appearance to the areola. This procedure is tolerated very well and may be done via local anesthesia or general/sedation with minimal recovery time.
The other popular technique is areolar repigmentation, which is performed by tattoo of the NAC. Usually this area of the reconstructed breast still has little to no sensation from the previous surgery, and the tattoo needle is tolerated very well. As with a standard tattoo, pigment is injected into the superficial dermis to color the area in a pleasing areolar color of your choice. This, as well, gives a great appearance to the areola. This is my preferred method. I perform this with only topical anesthetic in the office as a short procedure. Completion of the NAC also will cover much of the scars that are present, thus ameliorating and hiding the scarring from the incisions.
Both techniques are very simple to perform, are benign procedures with little to no down-time, and will give an excellent appearance of the NAC to complete the breast reconstruction.