Less than 50 per cent of women undergoing breast reconstruction take up the option of nipple reconstruction. When it is done, it is normally better to wait until the breast reconstruction has settled, the scars have softened, and thus the position of the new nipple can be matched as nearly as possible to that of the other breast.

There are various techniques which can be used to create a nipple and areola. The nipple is usually reconstructed from local skin or skin from the other nipple, and the areola from skin grafted from the groin area or from the other areola. Colour may be added to the areola, and its irregularities beneath the skin can be simulated with cartilage grafts.

However, with time, the projection of the nipple may be affected by natural changes which can make the long-term results of this process disappointing. There is also often a difference in the colour of the areola when compared to that on the unaffected breast.

An alternative is to use an external nipple prosthesis, which can sometimes be held in place by suction rather than being attached with adhesive.

Timing of breast reconstruction

Most of the reconstructive procedures described above can be done at the same time as a mastectomy, although the more complex ones are usually best left to a later date – which may be anything from a few weeks to many years.

When reconstruction is undertaken depends largely on the nature of the cancer, on the preferences of the surgeon and the woman herself, and on the availability of a reconstructive surgeon. Do discuss your options with your surgeon and ask for time to consider them if you want to.

Surgery to the opposite breast

The aim of reconstructive surgery is to create a breast which matches the unaffected breast as nearly as possible, and this may sometimes only be achieved by performing additional surgery on the other breast. This surgery may be performed before, at the same time as, or after the reconstructive surgery, and the decision as to when it is done will depend on various factors which the surgeon should discuss with you. Reduction mammoplasty can be carried out to reduce the size of a large breast, but although a normal-looking breast with normal sensation can be achieved, the resulting scars can be quite large. A droopy breast can be uplifted by a process known as mastopexy. Your reconstructive surgeon will be able to discuss these possibilities with you.

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