Nipple Reconstruction

thenexttweety

My tale of double mastectomy, chemo and hair loss, reconstruction via expanders and finally the new prostheses at age 65 is much like many I've read on this board. However I have been unable to learn much about the experiences anyone has had with reconstruction of the missing nipples. I have an appointment next Tuesday, July 1, with the university medical school connected plastic surgeon who has done all my surgeries in this connection to date. At first I told her that I saw no need for nipples at this stage of my life, but I allowed her to persuade me with facts like that my insurance covered it and everyone else does! Since I trust her completely and have been quite satisfied with her treatment I probably haven't learned as much as I should have about this final step. More than once she has referred to this procedure as something as simple as tatooing, to be done under local anesthetic right in her office. I did not know that customarily nipple reconstruction involves considerably more than that until I read some of the posts on this board. If possible I would appreciate input from anyone knowledgeable about this last phase of my reconstruction process. Has anyone else undergone tatooing only and been satisfied?

DeeNY711

Tattooing has joined tradition nipple reconstruction as an option with a lot of appeal. Cablevision's The Health Network program "Cutting Edge" had information about this fairly recent option, its cosmetic appeal, its minimal disruption appeal, its speed of being healed appeal...and if I were to consider reconstruction in the future, tattooing would be my choice. I appreciate your message because I chose to have bilateral mastectomy without reconstruction in order to allow the quickest simplest healing of tissue prior to starting chemotherapy. I figured that if after chemo, radiation and tamoxfen all is well, maybe I would revisit the possibility of reconstruction. I'll be 61 at that time. I salute your intrepid spirit and will keep it close to heart. Love, Denise

banker

Hi, I like your attitude. I am 59, had BC in 1998,mastectomy, chemo, 1yr later tram flap reconstruction, 6 mo later the nipple. There are a couple of ways to have it done, one being a sort of zig zag procedure done right on the breast, under local if needed, or skin is taken from the inner thigh and crafted as a nipple. When that is healed, the areola can be tatooed. I had the zig zag procedure, was done at the hospital, outpatient, no local anaesthetic was needed as my new breast was numb, no pain, no complications. Then the tatoo, looks great, only it faded a little. I am very happy with the result. Looks real. I wish you the best in making your decision, if you have any questions, feel free to email me at charmin@froggernet.com
Take care and God bless....Emmi

blossomtime

I was so glad to see your posting and the responses to it. I just had the expander exchanged for my implant. When I saw the dr for first postop visit I asked about the nipple reconstruction. Maybe I am sensitive but he made me feel that most people dont go on for this, they are happy just to have a breast back. Also stated that only 25% of women over 50 opt for this (I turned 50 in march). So was glad to see I am not only one out here, over 50, wanting to complete process of reconstruction. Also glad to know there was more than one technique. Good luck with your procedure. Keep us posted, very interested in subject.

thenexttweety

Ladies, I so appreciate your responses. I was also pleased to find someone through the chat board with some information. I have been stunned by the lack of information on this phase of reconstruction available on the net, especially when considering the many sites on related subjects. Believe me, I intend to find out everything I can from my plastic surgeon before proceeding on Tuesday. And I promise to report back what I've learned.

DeeNY711

blossomtime said:

I was so glad to see your posting and the responses to it. I just had the expander exchanged for my implant. When I saw the dr for first postop visit I asked about the nipple reconstruction. Maybe I am sensitive but he made me feel that most people dont go on for this, they are happy just to have a breast back. Also stated that only 25% of women over 50 opt for this (I turned 50 in march). So was glad to see I am not only one out here, over 50, wanting to complete process of reconstruction. Also glad to know there was more than one technique. Good luck with your procedure. Keep us posted, very interested in subject.

Your surgeon did you a great favor in tipping you off to the fact that your best bet is to find a surgeon who specializes in nipple reconstruction. If this is unfamiliar ground for him, the unpredictable outcome for both him and you would be an issue. Hugs, Denise

thenexttweety

I'm sure you haven't all held your breath waiting for the call-back I was expecting, after a jittery weekend, from Lynnette, Dr. Barone's nurse. But I think you'll want to know what she said. I told her my concerns, that the only descriptions of procedures I'd been able to read here and elsewhere on the Net were quite different from what I'd been led to expect tomorrow. In all cases where there was tattooing, it seemed to be done after surgical reconstruction of one kind or another. She said that could be true, however the tattooing I am to receive tomorrow is merely the first step. About three weeks later I go back for the surgical bit to be done inside a quarter-size circle already tattood the right color! (That makes sense!) Then after another short delay there is yet more tattooing, if I understood her correctly. She said my doctor has done a great many of these this way there at the University of Missouri MedCen, and they turn out very nice looking!

I am relieved ...... and again confident.

wordco

thenexttweety said:

I'm sure you haven't all held your breath waiting for the call-back I was expecting, after a jittery weekend, from Lynnette, Dr. Barone's nurse. But I think you'll want to know what she said. I told her my concerns, that the only descriptions of procedures I'd been able to read here and elsewhere on the Net were quite different from what I'd been led to expect tomorrow. In all cases where there was tattooing, it seemed to be done after surgical reconstruction of one kind or another. She said that could be true, however the tattooing I am to receive tomorrow is merely the first step. About three weeks later I go back for the surgical bit to be done inside a quarter-size circle already tattood the right color! (That makes sense!) Then after another short delay there is yet more tattooing, if I understood her correctly. She said my doctor has done a great many of these this way there at the University of Missouri MedCen, and they turn out very nice looking!

I am relieved ...... and again confident.

I can shed some light on the nipple reconstruction process, having just researched and written a book about this (and gone through my own bilat. reconstruction last year).

Most women who have reconstruction do have nipples reconstructed, but it is purely optional. Nipples used to be commonly made with a skin graft from the thigh or ear (the skin there is darker), but are commonly made from a flap of breast skin now. The areola is either done with a tattoo or a skin graft, depending on the nipple technique (there are many ways this can be done).

A few tips about this: First, it's always a good idea to look at your surgeon's photo portfolio of other nipple reconstructions.
While many surgeons are expert at constructing nipples, some hurry through the tattooing. All tattooing fades within a year, so it's usually applied quite a bit darker than what you want the final result to be. It also lasts longer and more evenly if it's applied in two or three layers (sessions). Many women just have their areolas tattooed with a darker "nipple" tattoo in the center.

Probably the most important thing to know about reconstructed nipples is that they will always be standing at attention. Because they lack nerves, they don't flatten or respond to touch or cold like normal nipples do...so you'll always have erect nipples under your clothes...So when discussing this with your surgeon, it's a good idea to talk about how big you want them to be.

The very best of luck and health to you!