The breast is defined by its shape. However, a perfectly recreated breast always needs an areola, the element which makes the brain recognize the visual aspect of the breast.
The reconstruction of the areola is generally performed as the final stage of a breast reconstruction.
The areola is made of the nipple-areolar complex, which is an areola with a nipple in its center. The surgeon will recreate 2 isolated structures:
- A colored flat disc (the areola)
- A colored tuber with some volume (a nipple)
Different reconstruction techniques can be used for the areola and for the nipple:
For the areola:
- A tattoo: a dermographologist recreates an optical illusion of the areola using a tint as close to the contra lateral areola as possible.
- A skin graft: a small circle of skin is removed from the genitocrural area (past the labia majora, where the elastic of panties goes). Dissolvable stitches are used to suture the donor area. Over time, the transplant will acquire a pigmented tint which will approximate the color of the other areola.
For the nipple:
- A local flap: a small piece of skin is removed from the reconstructed breast and “folded” as a paper hat to create a nipple.
- A contra lateral nipple graft: when the other nipple has a sufficient size, a small part can be used to replace the missing one. This way the created nipple is as close as possible to the existing one and its sensitivity is not affected.
Before the procedure
If genitocrural skin is transplanted, depilatory cream or wax should be used for a perfect depilation.
The nipple-areola complex reconstruction is done in the day care department and usually lasts 1 hour. The patient can leave the hospital the same day of the surgery. A local anesthesia is usually sufficient, but it may be combined with a neuroleptanalgesy or a short general anesthesia.
After the procedure
A padded covering secured to the surrounding skin with sutures called a bolster will be kept 4 to 7 days on the treated areola. The areas where skin was removed from do not need any specific aftercare. It should be noted that a reconstructed areola will never present the same sensitivity as the previous areola.
After removal of the bandage, daily showers are permitted and new garments can be done at home by the patient using paraffin tulles. The definitive result (color and texture) will become apparent after about 6 months.
The reconstruction of the nipple-areolar complex is often performed at the same time as the symmetrization of the contra lateral breast (breast ptosis, breast reduction, implant) when this procedure is carried out.
The first shower is permitted the day after the surgery but baths should be avoided during 1 month. The scars need to be protected from the sun during 1 year after the surgery in each and every case.
For more information, please consult the fact sheet of the authority of the French Society of Plastic Reconstructive and Aesthetic surgery (Société Française de Chirurgie Plastique Reconstructrice et Esthétique – SOFCPRE).