Reconstruction of the nipple-areolar complex and symmetrizing of the contralateral breast

Mastectomy means the ablation of the mammary gland, of a section of skin and of the areola.
After reconstructing the volume and the shape of the breast, a reconstruction of the nipple-areolar complex (areola+nipple) may be carried out in order to fully restore the symbol of femininity that the breast represents. This simple reconstruction allows a better integration of the reconstructed breast in its own physiological model. The surgery can be carried out when the volume of the reconstructed breast has stabilized.

There are different techniques of areola reconstruction:

• Complete skin graft.

The skin is ideally extracted from the genitocrural fold (groin fold) because in this area it is naturally pigmented and seems dark when it is grafted in the breast area. This pigmentation is not always sufficient to reproduce the colour of the contralateral areola but the result is lasting and usually natural. This skin section can be tattooed thereafter if necessary.
The peripheral half section of the other breast areola can also be used.

• Tattoo

is the most simple technique. It consists in introducing a sterile pigment in the skin. These tattoos tend to blur.

Other nipple reconstruction techniques exist, such as:

• Contralateral graft.

This is the preferred technique if the nipple is sufficiently developed and generous. A section is extracted and grafted on the other side. This technique implies minor scars and does not affect areolar sensitivity.

• Local flaps.

A local skin flap is extracted and rolled-up to create a central volume on the nipple. The scar related to the extraction is hidden by a skin graft or a tattoo which reconstructs the areola.

Before the procedure

It is recommended to stop smoking one month before and one month after the surgery (smoking can delay healing).
No aspirin-based medication should be taken during the 10 days preceding the operation.

The procedure

Type of anaesthesia: simple local anaesthesia if there is no associated procedure. A sedation can be administered to the most nervous patients.
Hospitalization: the procedure may be carried out in an ambulatory facility. Hospitalization is discussed if a more invasive procedure requiring a general anaesthesia is associated with the operation. The procedure usually lasts 30 minutes. At the end of the procedure, a light bandage is placed.

After the procedure

The follow-up is simple and you don't need to stop working. Pain is often moderated and well balanced by the usual pain-killers.
If a bolster is used (small ball of greasy compresses firmly applied on the graft), it will be removed by the surgeon between 5 to 7 days after surgery.
The other bandages can be placed by the patient herself: greasy compresses are applied on the graft every day.
With the first bandage, grafts often look very white (bloodless), but the color quickly appears and the graft becomes purplish-blue with some blood flowing. Crusting may appear. The unsightly appearance disappears in the following weeks and the graft becomes more pinkish.
Stitches are removed on the 21st day after the procedure.
It is advised to wait for complete healing before moistening the graft (be careful with showers).

Complications are rare but
it is still possible the transplant fails. In this case, a new transplant can be carried out.

The result

After healing, the pink and soft areola gives the breast a natural and complete appearance, it becomes again a symbol of femininity.