Nipple and Areola Reconstruction Techniques

November 28, 2013

Women that require a mastectomy and are seeking to undergo breast reconstruction may be curious about the techniques regarding reconstruction of the nipple and areola. Many options are available and should be discussed with the plastic surgeon.

Nipple-sparing Mastectomies

Some women are eligible for nipple-sparing mastectomies. This means all the breast tissue, except for the nipple, and sometimes the areola, is removed.

Tissue Banking

During a mastectomy, the surgeon can save all or part of the patient’s nipple and areolar tissue that is later grafted on one or more of the breasts after they are reconstructed. Surgeons can also bank tissues from other parts of the patient’s body. These areas can include the buttocks, ear, groin, upper medial thighs, and vulva. Donor skin is also available, though there is a risk of contamination from donors. From this skin, a natural-looking nipple and areola are created.

Nipple Reconstruction

Once tissue is harvested from the body, a plastic surgeon will use it to recreate the nipples. Nipple reconstruction is usually a separate surgery from the breast augmentation portion of the breast reconstruction process. With nipple reconstruction, the goal is to attach the newly grafted skin to the skin of the breast in a way that is both aesthetically pleasing and allows it to receive adequate circulation. There are two primary techniques doctors use. The first involves taking a piece of skin from the back or abdomen, without removing it from its blood vessels and grafting it to the breast mound. The second involves removing the skin from its blood source before grafting. Some of the techniques used by plastic surgeons include: 

  • Skate flap technique
  • Bell flap technique
  • Double opposing tab flap technique
  • Star flap technique
  • Trapeze flap technique
  • Arrow flap technique

These techniques refer to the way the new nipple is applied to the breast mound.


The nipple-areola complex can be tattooed on, or tattoos can supplement a skin graft. Tattooing in recent years has improved dramatically as there are a wide variety of natural pigments available.


Mass-made and costume silicone and polyurethane nipples and areolas are available. Both come in a variety of colors and sizes, though the costume ones are a bit more detailed.

General Tips

Nipple reconstruction, breast augmentation, and mastectomies all require general anesthesia, it is best not to eat or drink anything for eight hours before surgery.

Before both the mastectomy, and especially before reconstruction, strive to be in the best health possible. This means maintaining a healthy weight to the best of your ability and refraining from cigarette smoking. It may also mean avoiding certain medications that thin the blood, including NSAID pain relievers, for several weeks before surgery.

Know that you should have someone to help you for the first 24 to 48 hours after each procedure, as your mobility will be limited.

Breast cancer support groups are an excellent resource for patients undergoing a mastectomy and breast reconstruction.

For more information about nipple reconstruction, contact Crawford Plastic Surgery.

Add new comment