Nipple reconstruction is usually a part of the final stage of breast reconstruction. A nipple reconstruction can be done as an office procedure, but sometimes is incorporated with revision of the reconstruction in the operating room. In our practice we perform the nipple reconstruction, and then tattooing of the areola as a separate procedure.
In simple terms, the nipple is made from elevating skin and folding it in a way that leaves a ‘nub’ of skin that looks like a nipple. In medical terms we refer to the skin elevation as “elevating a flap”, and the flaps described for nipple reconstruction are numerous. We may use a different flap design based on the needed size, width, or projection – either to match the other side (for one–sided reconstruction) or based on the patient’s goals (for two–sided reconstruction). Importantly, though the final product may strongly resemble an actual nipple, the reconstructed nipple does not have sensation or ability to change with temperature changes, and lacks erogenous sensation.
You can also watch the following 9 min video to see the specific steps involved in a nipple reconstruction done in the office.