Nipple(s): to reconstruct or not?
Special Guest Blog:
The long debated topic of nipple reconstruction broken down by Dr. Ramon Garza III, board-certified plastic and reconstructive surgeon of Dr. Garza Plastic Surgery in San Antonio, TX.
Dr. Garza does a Perk Up take over to chat about his views on nipple reconstruction versus 3D nipple tattoos, and breaks down how he approaches the topic with each patient.
Here are his thoughts:
Consultation
My approach to nipple reconstruction is similar to my approach to breast reconstruction, or any surgery I do. Simply, what does the patient prefer? Certainly, there are clinical situations where one option might be better than the other, especially for implant-based reconstruction, but in general consultations with me are educational rather than a “this is what you are going to get” approach.
More recently, I have noticed a trend of patients wanting 3D nipple reconstruction, where a tattoo alone is used to recreate the illusion of a projected nipple bud as well as the texture of an areola. I think it is a great option for patients who want a quick recovery or perhaps prefer to not wear a bra.
Implant-based Reconstruction and nipple restoration limitations
I think 3D nipple tattooing is the best option for patients who have had an implant-based reconstruction as these patients are a bit more challenging with regard to a surgically created nipple. Why is that? Surgically created nipples rely on the thickness of the dermis and underlying fat to create long-standing nipple projection.
For patients who have had an implant-based reconstruction, the dermis and underlying fatty tissues are usually thin and long-term nipple projection is not possible. Additionally and more importantly, doing a surgically created nipple over an implant puts the implant at risk of infection. If an infection occurs, the implant has to be removed. Reconstruction at that point becomes complicated.
Nipple restoration options with tissue-based breast reconstruction
For autologous tissue patients (those who have undergone DIEP or other flap reconstruction), my conversations involve explaining pros and cons of each approach. For a 3D nipple, the pro is that the illusion is very good from a front view, the recovery is quick and relatively easy, and patients can often go braless. The con is that the nipple is flat and from a side view it is obvious that the “projection” created with artistic tattooing is an illusion.
A surgically created nipple bud can create projection that looks very realistic. It is different from a natural nipple, though, in that it does not have erectile tissue so it will not change in size or projection with stimulation or with cold. Sometimes this skin area can have re-neurotization from the surrounding nerves or from a nerve connection done during the reconstructive surgery, but the sensation restored is not perfect and often sensual touch is not restored. Once the surgically created nipple has healed, tattooing can be performed to recreate the areola color.
Combining forces, or as we like to call it, “4D”
For the most realistic nipple and areola reconstruction, a combined surgically created nipple and 3D tattoo is the best approach. The 3D tattooing adds depth to the surrounding areas by recreating the illusion of textures visible on the areola and nipple.
You’re the boss!
After the discussion, I show the patient pictures of everything described above and let them see for themselves how it actually looks. If they decide that a 3D tattoo is what they are leaning towards, I will generally send patients to Perky so that they can chat with Courtney and Crystal about the Perky 3D nipple restoration approach.
Special thanks to Dr. Garza for giving us your perspective on nipple restoration options!
