Understanding Areola Reconstruction in New York City
Areola reconstruction is an important part of the breast reconstruction process, especially for those who have undergone mastectomy or other breast - related surgeries. It can significantly enhance the natural appearance of the breast and improve the patient's body image and self - confidence. In New York City, there are several hospitals and surgical practices that are highly recommended by those who have had areola reconstruction surgery. Let's take a closer look at some of these institutions.
Leading Hospitals and Practices for Areola Reconstruction
New York Plastic Surgical Group
The breast reconstruction surgery center within the New York Plastic Surgical Group, a division of Long Island Plastic Surgical Group P, is known as a “center of excellence”. The plastic and reconstructive surgeons here have extensive experience, having performed more than 10,000 breast reconstruction procedures, including all major breast reconstruction techniques.
They offer two main approaches to nipple reconstruction: graft nipple reconstruction and flap nipple reconstruction. In graft nipple reconstruction, the plastic surgeon takes skin from a donor site and attaches it to the newly constructed breast. The donor site for the nipple can be from the nipple of the other breast (in single - breast mastectomy cases) or from the earlobe or labia (in double - mastectomy cases). The donor site for the areola can come from areas such as the scar from a flap reconstruction procedure, the crease of the buttock, or the inner thigh. Flap nipple reconstruction involves creating the nipple from a skin flap taken from the area beside the region where the new nipple will be placed. This approach keeps the original blood supply flowing into the new nipple, provides a greater chance for successful acceptance of the graft, and typically results in less scarring.
They also offer nipple tattooing on an outpatient basis, which is the final step in the nipple reconstruction process. The surgeons at the New York Plastic Surgical Group take the time to cover all aspects of breast reconstruction surgery during the initial consultation, including nipple reconstruction options, to help patients make informed decisions.
Constance Chen, MD - Plastic and Reconstructive Surgery Practice
Dr. Constance Chen is an expert in restorative techniques such as breast and nipple reconstruction. Her practice in New York City caters to patients who have questions about nipple reconstruction. Nipple reconstruction here is usually performed to reconstruct the nipple - areola complex after a traditional mastectomy, where the nipple - areola complex is resected, or to correct nipple deformities like inverted nipples.
The best candidates for nipple reconstruction at this practice are healthy non - smoking patients at their ideal body weight and without major medical comorbidities to minimize the risk of post - surgical complications. For nipple reconstruction after mastectomy, common techniques include using a flap of skin from the surrounding breast skin, the nipple - sharing technique (for unilateral breast reconstruction with a large native nipple on the other side), and using a flap of skin from the groin. After the nipple is reconstructed, a plastic “nipple house” is placed over it for protection for one week, followed by a soft nipple dressing. The areola is completed by tattooing the surrounding breast skin after the nipple has healed.
Dr. Chen listens carefully to the aesthetic goals of the patients and strives to deliver some of the best breast augmentation and reconstruction results in New York while prioritizing patient safety.
Oren Z. Lerman, MD - Manhattan Practice
Dr. Oren Lerman, the director of breast reconstruction at Lenox Hill Hospital's Institute for Comprehensive Breast Care in New York and director of the breast reconstruction fellowship, offers nipple reconstruction services. Many breast reconstruction patients come to him to fully restore the appearance of their breasts after a mastectomy and breast cancer treatment.
The nipple reconstruction procedure at his practice is a two - part process. First, a small procedure is done to create the elevated appearance of the nipple projection from a flap of the patient's own skin. After it heals, 3D tattooing is performed by specialized tattoo artists with experience in creating realistic nipple dimensions and areola definition. The procedure is an outpatient one that can be performed under local anesthesia, and patients typically wait three to four months after the initial breast reconstruction (either flap reconstruction or breast implants) before scheduling the nipple reconstruction.
Dr. Lerman takes the time to discuss options and goals with patients during the consultation, and he also provides after - care instructions to ensure a smooth recovery and the best possible results.
Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center provides detailed information and high - quality care for nipple and areola reconstruction using a skin graft. The center educates patients on what to expect before, during, and after the procedure.
Before the procedure, patients are required to arrange for someone to take them home, and they have a presurgical testing (PST) appointment. During the PST, they meet with an advance practice provider who reviews their medical and surgical history, and may order tests such as an electrocardiogram, a chest x - ray, and blood tests. On the day of the procedure, patients bring loose and comfortable clothing. After changing into a hospital gown, an intravenous (IV) line is placed, and the surgeon explains the procedure.
During the areola reconstruction, a skin graft is taken from a donor site (most commonly the groin) and moved to the recipient site around the reconstructed nipple. The whole procedure usually takes about 60 to 90 minutes if it is the only procedure, but it may take longer if combined with other surgeries. After the procedure, patients are monitored in the post - anesthesia care unit (PACU) and are given a prescription for mild pain medication. They are also provided with detailed post - operative care instructions regarding clothing, wound care, showering, pain management, and physical activity.
Techniques in Areola Reconstruction
Nipple Reconstruction Techniques
There are several nipple reconstruction techniques used in New York City hospitals:
- Local Flap Technique: This is the most commonly used technique. Surgeons use a skin flap that usually includes the local skin and the superficial layer of the underlying subcutaneous tissue. Popular flaps include the arrow flap, the C - V flap, and the C - H flap. However, maintaining the nipple's projection over time can be a challenge, and sometimes the repetition of the same flap is necessary after the first surgery.
- Use of Autologous/Allogenic/Synthetic Grafts: To overcome the loss of projection, various materials can be grafted inside the new nipple. Autologous tissues like fat, cartilage, and derma; allogeneic tissues such as acellular dermal matrix and lyophilized allogeneic costal cartilage; and synthetic materials like fillers can be used. Studies suggest that autologous tissue grafted inside the nipple has led to the best results.
- Nipple Sharing Technique: This technique is applicable only in cases of unilateral breast reconstruction. It involves taking a skin graft from the contralateral nipple. The breastfeeding functionality can be preserved using a modified nipple - sharing technique that does not damage the anatomic structure of the donor nipple for breastfeeding.
Areola Reconstruction Techniques
- Skin Graft for Areola: The areola can be reconstructed using a skin graft from hyper - chromic skin areas such as the inguinal (inner thigh skin), the axillary region, or the labia minora skin. The surgical operation is relatively easy, and the healing process in both the donor and recipient sites is generally fast. However, the pigmentation of the skin graft may fade over time, and it is not uncommon to perform the skin graft again one to two years after the initial graft.
- Tattooing for Areola: Tattooing of the areola is commonly performed four to six months after the surgical reconstruction of the nipple. It is an easy - to - perform outpatient procedure that can be done by a non - medical professional as well. It is a safe procedure and leads to a high level of satisfaction. Tips for tattooing include blurring the areola margin, creating the illusion of the Montgomery glands, adjusting the areola position to achieve symmetry, and creating the illusion of the height of the nipple by using shading.
Benefits of Areola Reconstruction
The benefits of areola reconstruction are numerous:
- Enhanced Aesthetics: It makes the surgically reconstructed breast look more natural. The coloring, size, and projection of the nipple and areola can be customized to suit the patient's body type and former appearance.
- Emotional Well - being: After breast cancer treatment, plastic surgery can have a profound impact on the emotional recovery of a patient. Restoring the areola and nipple helps patients feel “normal” and “whole” again, improving their self - confidence and body image.
- Quality of Life: Patients who feel confident in their own skin often experience improvements in their personal and professional lives. Their self - esteem and body image are important elements of their mental health and overall quality of life.
Pre - operative Considerations
Before undergoing areola reconstruction, patients need to consider the following:
- Overall Health: Patients should be in good overall health, non - smoking, and at their ideal body weight. Major medical comorbidities should be addressed as they can increase the risk of post - surgical complications.
- Consultation: A consultation with a plastic surgeon is crucial. During the consultation, the surgeon will examine the patient's overall health, review the patient's goals and expected outcomes, and physically examine the breast area and take pictures. The surgeon will also explain the procedure, the risks involved, and the expected healing time.
- Financial Considerations: The cost of areola reconstruction in New York City can vary based on a number of factors. It is important to have a consultation with a physical examination to develop a surgical plan, and then discuss the cost estimate and insurance options with the patient coordinators.
Post - operative Care and Recovery
The post - operative care and recovery process is different for surgery and tattooing procedures:
After Surgery
After areola reconstruction surgery, patients usually go home the same day. A plastic “nipple house” is placed over the new nipple for one week, during which patients cannot shower and should have sponge baths only. After one week, it is replaced with a soft nipple dressing, and patients can shower normally during the second week. Two weeks after the surgery, no dressing is needed. Patients may also experience soreness and swelling, and the surgeon will provide medication to mitigate these side effects. The nipple may lose some of its projection and color over time, but the tattoo artist can refine the definition of the areola and the shading. It takes about three months for the body to heal from the surgery, and during this time, patients should avoid physical activities that may strain the incision on the donor site.
After Tattooing
After a nipple tattoo, the surgeon or artist will wrap the skin in a bandage or plastic wrap. They will let the patient know how long to keep the bandages on and what creams or ointments are best to help the tattoo heal. The new tattoo may be itchy, and patients should avoid scratching it. The skin may peel, but patients should let the flaking skin fall off naturally. The skin usually heals in about seven to 10 days.
Potential Complications
Although the incidence of complications in areola reconstruction is generally low (0 - 11%), some possible complications include:
- For Surgery: Swelling, bleeding, scarring, infection, loss of projection or flattening of the nipple over time, loss of feeling in the breast, necrosis or loss of tissue, and changes in nipple placement with age.
- For Tattooing: Delayed hypersensitivity reaction, nipple - areolar complex partial necrosis, allergic contact dermatitis due to pigment reaction, and fading of the pigment over time.
Conclusion
Areola reconstruction is a significant part of the breast reconstruction journey for many women in New York City. The city offers several top - notch hospitals and practices with experienced plastic and reconstructive surgeons who can perform a variety of areola reconstruction techniques. From nipple reconstruction using local flaps or grafts to areola reconstruction with skin grafts or tattooing, patients have multiple options to achieve a natural - looking result. Understanding the pre - operative considerations, post - operative care, and potential complications is essential for a successful areola reconstruction process. It can greatly enhance the patient's physical appearance, emotional well - being, and quality of life.
If you are considering areola reconstruction, we encourage you to reach out to one of the recommended hospitals or practices in New York City. Schedule a consultation with a qualified plastic surgeon to discuss your options and goals. You can also share this article with others who may be interested in learning more about areola reconstruction.
