Breast reconstruction after a mastectomy is process, not a single step. Now that I have had the tissue expanders removed and the permanent implants placed, the next step is nipple grafting. The nipple reconstruction surgery typically is not attempted until 3-6 months after the implant part in order to give the body time to heal and for the implants to soften and drop.
There are a couple of options when it comes to nipple reconstruction.
Nipple grafting is the first option. A nipple graft involves taking skin from somewhere else on the body and moving it to the breast where the nipple should be. The top layer of skin is removed from the reconstructed breast at the site of the nipple, and the graft attached in its place. The skin used for the new nipple can be taken from the inner thigh, opposite nipple, labia, toe pulp, earlobe or part of the reconstruction scar. Nipple grafting is then completed with areolar tattooing to provide a natural looking color to the nipple and surrounding darker skin. Disadvantages to nipple grafting are that the new graft is not transferred to the nipple site with a blood supply. Instead, it needs to establish a new blood supply from the reconstructed breast, which occasionally does not happen, resulting in graft failure. Also, grafts tend to flatten over time and, if hair-bearing skin is used to create the graft, hair will continue to grow from the new nipple. This can be treated with electrolysis or laser therapy.
Another option is a nipple flap. There are many types of nipple reconstruction using flap techniques, but they all involve freeing a small area of skin and fat from the surface of the reconstruction and twisting or folding it in a way to create a nodule on the surface of the breast, which is sutured in place. Tattooing is again used to provide a natural looking color to the nipple and surrounding darker skin. The new nipple shrinks over the first year, so is made ‘too big’,but the flap based nipples are less likely to flatten or lose their shape. The disadvantage is that new scars are created in the skin around the nipple, but these can be well hidden with tattooing.
Complications that can occur from nipple reconstruction:
1. Infection – This can range from an infection of the nipple which can be easily treated with antibiotics, or can become more severe and result in the implant needing to be removed due to the infection.
2. Flat/Graft failure – The tissue may not make a good blood supply and will not survive. If this happens then the surgery will need to be repeated.
3. Nipple collapse – The nipple tissue may flatten
4. Poor position – They may not be even if a bilateral mastectomy was performed.
After having said all of this, I will let you know what I have decided to do. AAfter discussing this with Nick, I have decided not to go through with nipple reconstruction. This will mean that my breasts will have 4 inch incisions across both breasts and will not have nipples, but the risk of yet another surgery is not worth it to me to have new nipples. Nick has been extremely supportive while I weighed my options and came to my decision. He says that he is just happy to have me here with him alive and nipples are the last thing for him to worry about. He has told me that if I chose to go through with the surgery to make sure that I am doing it for ME and not because I think he would want me to do it. So, after months of thinking and researching the topic, I have decided that my body has been through enough and I am not going to go forward in the reconstruction process. This is something that is very personal and means something different for each woman. I support the decision that any woman makes when going through something like this. I am very confident in my choice and am relieved to have finally made a final decision.