Nipple Reconstruction
Nipple reconstruction can be performed as a standalone procedure or in combination with other breast procedures such as flap volume adjustment (with liposuction), modification of the opposite breast with breast lift/reduction, or scar revision.
This surgery is for women who want to complete the final step of reconstruction. It is a simple procedure that can make a huge difference to the look of a reconstructed breast, making it closely resemble a native breast.
Nipple reconstruction creates the mound of the nipple itself while the areola colour is provided by visiting a medical tattooist after your nipple reconstruction has been completed.
Dr Aggarwal at MODE will be happy to guide you through the consultation process and advise what surgery may be able to achieve what you are looking for.
- Anaesthetic: LA
- Time: 30 minutes to 1 hour
- Duration of stay: Day procedure
- Hospital: Can be done in rooms or in day surgery settng
- Medicare/Health fund rebate: Yes for nipple reconstruction. There is no medicare or health fund rebate for tattooing the areola.
- Recovery: Most people can do most things straight away. Avoid swimming in a pool or beach for 2 weeks.
- Results: Predictable and generally very good. Results can vary between patients.
Procedure Information
- The procedure is usually performed under local anaesthetic in rooms or in a day surgery setting
- It can be performed after implant reconstruction, latissimus dorsi flap or after autologous flap (DIEP, msTRAM or TUG flaps).
- Dr Aggarwal uses different techniques for nipple reconstruction, all of which aim to match the reconstructed nipple as closely as possible to the opposite breast. In general we avoid the use of skin grafts for nipple reconstruction.
C-V Flap
- This is commonly used
- It involves lifting a small flap of skin as in the diagram and folding it much like origami, to create a nipple.
- The area from which the flap was lifted is closed directly
Double opposing flap nipple and areola reconstruction
- This is commonly used by Dr Aggarwal for autologous flap nipple reconstruction
- An ellipse of skin is used – the centre of it is used to raise a flap much like the C-V flap described above. This is folded to create a nipple
- The areola edge is then incised and undermined.
- All the incisions are then closed.
- This technique has the advantage of imparting some colour to the areola as the initial scars are pink.
- Dr Aggarwal will place waterproof dressings over the incisions. Under the waterproof dressings will be dressings placed around the nipple to prevent them being compressed with a bra.
- You will be able to shower after 48 hours and can continue to wear a normal bra with some padding so your bra does not compress the area of the nipple reconstruction
- You will not be allowed to swim in a pool or beach for at least 2 weeks after surgery.
- You will be given a script for antibiotics by Dr Aggarwal which you must continue until the box runs out
- You will also be given pain relief medications although most patients only report minor amounts of post-operative pain that is responsive to simple oral analgesia.
- If you have had only local anaesthesia, you will be able to go home on your own, and you may drive home. If however you elect to have some sedation you will not be allowed to go back home on your own – you must have someone accompany you home, and you should not drive for at least 24 hours after surgery.
- While most sedentary activities can be resumed in the first week, you must not do any exercise for the first few days after surgery that could raise your blood pressure.
- Dr Aggarwal will see you a week after your procedure to inspect how the wound is healing. You will be given instructions how to look after the wound as it continues to heal. You will be able to ask questions about what you can and cannot do.
Risks & Complications
- Bleeding (1-2%) – any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. Usually this settles with compression.
- Infection (<1%) – this is very rare. However you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.
- Poor Wound Healing (2%) – This is usually rare but slow healing usually resolves with dressings and simple wound care.
- Nipple compromise – this is a rare but sometimes the flap used for nipple reconstruction becomes compromised. If it fails completely then a different technique of nipple reconstruction will have to be used.
- Asymmetrical nipple shape or size – There can be a difference in how the nipple reconstruction looks to the native nipple, or a difference between the two nipple reconstructions in a bilateral case. However the aim is to get them as symmetrical as possible.
- Hypertrophic or poor scars – How one’s body behaves to scarring is individual and largely genetic. Some types of skin are more prone to hypertrophic or keloid scarring, and some individuals and families are more prone to this. We will routinely advise you on how to improve the quality of scars over time. You should also discuss any history of abnormal scarring with Dr Aggarwal preoperatively.
Procedure FAQs
- It is advisable to obtain a referral for breast reconstruction as it is possible to claim a Medicare rebate of approximately $73 for the consultation if you have a referral
- A Medicare/Health Fund rebate may apply to you depending on your level of cover, and having a referral allows you to claim this.
- You can see Dr Aggarwal at the main rooms in Gordon, and he also consults at Hornsby, Hunters Hill and Camperdown.
- Please scroll to the bottom of the page to find out more information about these locations
- The procedure may be offered to you in rooms or at any of the hospitals where Dr Aggarwal works
- Cease fish oil, and other supplements such as Ginkgo, Ginseng.
- Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.
- If you are smoking you need to cease this well in advance of surgery as the risks of nipple flap compromise and poor wound healing significantly increase in smokers.
- No but you should have some padding under the bra to prevent compression of the nipple area for a few weeks after surgery
- You should not do any exercise that raises your blood pressure for at least 72 hours after surgery to avoid the risk of an unexpected bleed
- Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.
- Not usually.
- You may elect to see a medical tattooist to tattoo the areola, but keep in mind that this does not attract any rebates from Medicare.
- Yes
- However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.
- You may swim in a pool or beach after 2 weeks as this is the time it takes for the incision to heal.
- If you have had local anaesthesia only you may drive straight away
- If you have had sedation in addition to local anaesthesia you can drive after 24 hours.
- Yes
- There are temporary nipple tattoos that can be used
- Alternatively some medical tattooists can provide “3D” tattoing which when viewed from the front can resemble a nipple and areola reconstruction. However from the view from above there will be no protruding nipple.
- These are options for those who wish to avoid further surgery.
Procedure Pricing
- A Medicare item number usually applies to nipple reconstruction, and if you have appropriate health insurance cover, the out of pocket cost is around $2500-3000 for a bilateral nipple reconstruction.
- You are best to check with your health fund if you are appropriately covered.
- We cannot take responsibility for health funds rejecting claims for coverage of surgeon/anaesthetist or hospital fees.
- Unilateral nipple reconstruction alone will be less, but is often combined with modification of the opposite breast involving a breast lift or reduction.
- Please note that the above price does not include
- Preoperative consultation fees – which are $280 for the initial consult and $140 for additional preoperative consultations
- Fees for modification of the opposite breast
- Further surgery that may be required.
Meet Dr Aggarwal
Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.
What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at two of Sydney’s most prestigious public hospital campuses (RPA and POWH/RHW), and operates privately on the North Shore.
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Gordon NSW 2072, Australia
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