Nipple and Areola Reconstruction: Overview

The structure commonly referred to as a “nipple” is actually the nipple (center projecting part) and areola (surrounding pigmented part). For many women, nipple and areola reconstruction are the final surgical procedure of breast reconstruction. Nipple/areola reconstruction can be performed surgically or non-surgically.

What To Expect

In the pre-operative area, your surgeon will determine the optimal location for the nipple/areola reconstruction. Surgical nipple reconstruction involves folding of local skin flaps to create bulk and projection. The process is similar to origami, in which a flat piece of paper is folded into a 3-D form. The reconstructed nipple is based on soft tissues (skin and fat), and does not have a deeper supporting structure. Many nipple reconstructions lose projection (up to 50%) over time, and your surgeon may initially create a larger nipple to compensate for this expected outcome.

Nipple and Areola Reconstruction Procedure

Surgical areola creation requires a full-thickness skin graft, usually taken from somewhere else on your body. The graft is cut into a circle shape, and the nipple reconstruction can be brought through the central portion of the graft. The graft is set off visually by a having a different color and texture than the surrounding breast skin-much like a native nipple.

Series showing (left) reconstruction of right and left breasts with DIEP flap,
(center) reconstruction of nipple and
(right) final result after tattoo of areola.

Nipple and Areola Reconstruction procedures can also be performed as followed. Non-surgical areola creation can be performed using a tattoo. Similar to the surgically created areola, a tattooed areola is visually distinct from the surrounding breast skin. A surgical nipple reconstruction (to provide depth) is commonly paired with a tattooed areola to create a final nipple/areola complex reconstruction.

Before
After
Surgical creation of the left nipple with skin origami and areola with full thickness skin graft


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