Written by: Stuart A. Linder, M.D., F.A.C.S. on September 2, 2011
Patients often present with questions about reconstructive nipple surgery. Nipple deformities can include iatrogenic, congenital, traumatic or surgically-induced. Nipple deformities can include genetic or acquired such as congenital nipple hypertrophy. These can often be seen in Asian populations of women who simply have very enlarged nipples, significantly disproportionate to the size of the areolas. Surgery on these nipples can include a superior-based flap with resection of the inferior portion of the nipple. It can then be reduced by hemisection as well as removal of the lateral portions of the nipple. This can then be everted and sutured down and reduce the size of the nipple by 60%, maintaining good vascularity.
Traumatic nipple deformities can include trauma to the nipple, including burns. These can be reconstructed using free nipple grafts from the contralateral nipple as well as tissue flap reconstruction from the skin itself with pigmentation tattooing around the areola. Other nipple deformities can include aplasia, as may be seen in Polandís Syndrome where there is no nipple development. Once again, reconstruction using rotational flap in a pedicle fashion as well as skin grafting the areola from tissue from the labia majora has been used in order to regain similar color continuity to the contralateral side.
Surgically-induced nipple deformities can include constricted base of the nipple atrophy which can be associated with a breast reduction using the inferior pedicle or any breast reduction procedure where there is poor blood supply causing the death of the nipple and/or parts of the nipple and/or areola. Nipple reconstruction can be performed as described using full thickness skin grafts in this situation and possibly skin grafts taken from contralateral nipple areola or from the labia majora.
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Stuart A. Linder, M.D., F.A.C.S. is a Beverly Hills plastic and reconstructive surgeon specializing in breast augmentation, liposuction, tummy tuck, and more.
Dr. Linder is certified by the American Society of Plastic and Reconstructive Surgeons and is a diplomate of the American Board of Plastic Surgery.