Nipple Reconstruction Options
If nipple reconstruction is the next step in your breast reconstruction, congratulations, you are near the end of your journey! Nipple reconstruction is done at the end of the breast reconstruction once the patient is satisfied with the architecture (size, shape, symmetry) of the breast. The nipple reconstruction is a simple last step, but one that has much meaning attached to it. Many people view their breast as “just mounds” prior to the nipple reconstruction. Time and time again, we are floored by the reaction our patients have once they view themselves after the nipple reconstruction is complete.
Nipple reconstruction can be achieved by several options both surgical and nonsurgical. The three surgical options are: local flap reconstruction, skin grafting, and nipple autograft. The nonsurgical options are: 3D tattoo, temporary 3D tattoo, and prosthetic nipples. We will briefly discuss all these options in this blog.
We will discuss the nonsurgical options for nipple reconstruction first. The first of these options is the temporary 3D areola tattoos. These temporary tattoos come in multiple colors, usually last around 2 weeks, and can be removed with rubbing alcohol. The temporary tattoos are shaded to give them a three dimensional appearance. The following are two places where these temporary tattoos can be purchased: RubOnNipples.com and Fineartsmedicine.com.
The second, of the nonsurgical options, is prosthetic nipples. Prosthetic nipples are custom crafted from high quality skin safe silicone. The prosthetic nipples can be worn during and after breast reconstruction, stay in place during normal daily activities, workouts, intimacy, bathing, and even swimming. The prosthetic nipples can be purchased at: Naturallyimpressive.com . Naturally Impressive offers color matching to your natural nipple.
The third nonsurgical option is the 3D nipple tattoo. We are lucky to have a dedicated 3D nipple reconstruction tattoo artist in our office by the name of Jeff Paetzold. Jeff is one of a handful of tattoo artist in the country that dedicate much of their work to 3D nipple reconstruction for patient’s undergoing breast reconstruction. Jeff has been with our practice going on 6 years now. A 3D nipple tattoo creates the appearance of a projecting nipple without one actually being reconstructed. This is most frequently recommended for patients who have had radiation therapy as it involves less risk for healing problems and for patients who do not want to have their nipple reconstruction show through their clothes. At your appointment with Jeff, the desired color and size will be determined and the nipple and areola will be tattooed to create the appearance of a projecting nipple mound.
The first surgical option we will discuss is nipple autograft. Nipple autograft is essentially borrowing tissue from one nipple to reconstruct the other. This procedure is an option if you have retained your native nipple areola complex on the opposite breast and the native nipple has adequate volume. The nipple tissue from the native side is harvested and then grafted to the reconstructed side. This then makes the native nipple smaller, but helps create a new nipple on the reconstructed side that matches in pigment and texture. This would then be surrounded by an areola tattoo to complete the nipple areola complex. The borrowing of nipple tissue does not leave a perceivable scar in the native nipple.
The second surgical nipple reconstruction option is skin grafting. This is when skin from a different part of the body is harvested to recreate the nipple on the reconstructed breast. This procedure leaves a scar at the donor site (place where skin was borrowed from) and is not our preferred method for nipple reconstruction, but can be beneficial in some cases.
The third, and most common, surgical option for nipple reconstruction is local flap reconstruction which is done in two steps. This procedure uses skin on the breast to create the new nipple. The skin where the nipple will be located is cut, lifted, wrapped on itself, and sutured to create the nipple mound (first step). An areola tattoo is then placed surrounding the nipple mound once it is healed (second step). Many times, the old scar can be used to create this nipple mound if the location is favorable. Using the old scar and placing the areola tattoo many times helps camouflage the mastectomy incision.
Most insurance companies will cover one nipple reconstruction procedure for breast reconstruction. As described above, nipple reconstruction can be done in various ways. The two most common ways in our office is 3D nipple tattoo and local flap reconstruction. The difference between these two procedures is the 3D nipple tattoo is done in one step and the local flap reconstruction is done in two. Again, insurance companies will cover ONE nipple reconstruction procedure for breast reconstruction. If patients get the 3D nipple tattoo, this is done in one sitting and covered by the insurance company (outside of your deductible, copay, out-of-pocket, etc). If patients get the local flap reconstruction, the insurance company will only pay for one of the two steps. They will pay for the actual making of the nipple mounds, but not the areola tattoo that comes 3 months after the nipple mound has healed. The areola tattoo would then be paid directly to Jeff ($250 for one side and $400 for both sides for our patients; $500 for patients who completed their breast reconstruction in another practice).