Introduction

Areola and nipple reconstruction is a crucial aspect of breast reconstruction for many individuals who have undergone mastectomy or other breast - related surgeries. In New York City, several institutions stand out for their excellence in this specialized field. This article will explore the top five oral institutions for areola and nipple reconstruction in the city, as well as provide comprehensive information about areola and nipple reconstruction in general, including techniques, benefits, and patient considerations.

Top Five Institutions for Areola and Nipple Reconstruction in New York City

1. Rowe Plastic Surgery

Rowe Plastic Surgery has a well - deserved reputation for its expertise in nipple reconstruction and correction. Board - certified cosmetic surgeons at this institution are highly experienced in a wide range of breast procedures. They understand that the nipples and areolas play a significant role in the overall look and function of the breasts. For patients who have had a mastectomy, nipple reconstruction is often a vital part of the breast reconstruction process. The surgeons here offer various procedures, from creating the physical shape of the nipple to using medical tattooing for a natural - looking color. They also perform nipple correction surgeries to address issues such as enlarged, asymmetrical, protruding, or inverted nipples. Rowe Plastic Surgery is dedicated to providing personalized treatment plans to meet each patient's unique needs and expectations.

2. New York Center for the Advancement of Breast Reconstruction at New York Eye & Ear Infirmary of Mount Sinai

This center, led by Joshua Levine, MD, is a center of excellence in breast reconstruction. It offers state - of - the - art, muscle - sparing, and implant - free microsurgical breast reconstruction options for women of all body types. In the context of areola and nipple reconstruction, it has a team of world - renowned plastic surgeons and support staff who care for patients with expertise, compassion, and respect. They use the patient's own tissue (skin and fat) to make a breast, resulting in a more natural, long - lasting reconstruction. This institution is also known for being at the forefront of techniques such as the deep perforator flap technique and the nipple - sparing operation, which are not always available at other centers.

3. Plastic Surgery & Dermatology of NYC

At Plastic Surgery & Dermatology of NYC, Dr. Levine is highly skilled and experienced in all types of breast reconstruction, including areola and nipple reconstruction. The institution offers multiple breast reconstruction options, such as implant - based reconstruction and advanced tissue flap procedures. When it comes to areola and nipple reconstruction, they understand that it is the final stage that can significantly enhance the overall aesthetic result of breast reconstruction. They take the time to discuss with patients their goals and expectations, and help them navigate through the available options to make the best choice for their personal situation.

4. Healthgrades - Recommended Institutions

Healthgrades provides ratings for doctors performing nipple reconstruction in New York. Among the top - rated doctors are Dr. Philip Torina, MD with a 5.00 rating out of 5 stars, Dr. David Otterburn, MD also with a 5.00 rating, and Dr. Eloise Chapman - Davis, MD with a 4.90 rating. Institutions associated with these highly - rated doctors are likely to offer excellent areola and nipple reconstruction services. These doctors have extensive experience and are backed by positive patient reviews, indicating a high level of patient satisfaction with the care and results they provide.

5. Facilities with Comprehensive Breast Reconstruction Programs

Some facilities in New York City have comprehensive breast reconstruction programs that include areola and nipple reconstruction. These programs typically offer a multidisciplinary approach, involving plastic surgeons, breast surgeons, and oncologists. They work together to ensure seamless and advanced breast reconstruction, with a focus on both medical and aesthetic outcomes. The coordination among different specialists allows for a more comprehensive and personalized treatment plan for patients undergoing areola and nipple reconstruction.

Understanding Areola and Nipple Reconstruction

Importance of Areola and Nipple Reconstruction

The nipple - areola complex is the primary landmark of the breast. For patients who have lost their nipples and areolas due to cancer excision, trauma, or congenital absence, areola and nipple reconstruction can have a profound psychological impact. Studies have shown that the recreation of the nipple - areola complex (NAC) has a high correlation with overall patient satisfaction and acceptance of body image. It can help restore a sense of normalcy and femininity, and boost self - confidence for individuals who have undergone breast surgery.

History of Areola and Nipple Reconstruction

The history of nipple reconstruction parallels that of breast reconstruction with autologous tissue. It started with the initial description of the nipple - areola graft and labial graft in the 1940s. Over the years, various techniques have been developed, such as the nipple - sharing concept proposed by Millard, where the contralateral nipple tissue was used as a composite graft for the reconstructed nipple. In the 1980s, the description of the quadropod flap, dermal fat flap, and t - flaps brought about a paradigm shift in NAC reconstruction. More recently, the use of synthetic materials and allografts has introduced new innovative methods for projection augmentation and revisional NAC reconstruction.

Relevant Anatomy of the Nipple - Areola Complex

The nipple - areola anatomy is highly variable across ethnic groups and among individuals. The nipple itself may project as much as ≥ 1 cm, with a diameter of approximately 4 - 7 mm. The areola consists of pigmented skin surrounding the nipple proper and is on average approximately 4.2 - 4.5 cm in diameter. The central position of the nipple cylinder in the areola also has significant variability, ranging from one - fourth to one - half of the radius off - center. The contractile properties of the areola contribute to the gradual change in nipple projection obtained with direct or neural stimuli.

General Principles of Areola and Nipple Reconstruction Planning

Timing of Reconstruction

Ideal reconstruction of the NAC requires symmetry in position, size, shape, texture, and pigmentation and permanent projection. Generally, NAC reconstruction is postponed till the final and stable setting of the reconstructed breast mound, optimally 3 - 4 months following breast reconstruction. The timing is crucial as surgical decisions made too early may result in asymmetric placement of the nipple. Adjuvant therapies such as radiation and chemotherapy need to be taken into consideration as their tissue - healing effects may compromise final outcomes. The ideal timing for reconstruction is approximately 3 - 5 months after the last revisional reconstructive surgery, allowing for swelling and inflammation to subside and the breast mound to settle into its final position.

Template for Reconstruction

In unilateral reconstruction, the contralateral NAC serves as a template. In bilateral reconstruction, the surgeon must make use of standard values to create a nipple position, size, and areola size. A review of 600 breasts showed that the mean diameter of the areola is approximately 4 cm, with an average nipple diameter of 1.3 cm and an average nipple projection of 0.9 cm.

Anticipating Loss of Projection

Loss of projection of the reconstructed nipple should always be anticipated due to contraction. In NAC reconstruction with local flaps, overcorrection of 25 - 50% of the desired result is advisory to account for this loss.

Consideration of Previous Breast Reconstruction

The type of previous breast reconstruction is an important factor. Patients who undergo prosthetic - based breast reconstruction will have a thin, expanded skin - subcutaneous tissue base, usually with a centrally placed mastectomy scar. In autologous reconstruction, patients will typically have a variable - sized donor tissue skin paddle with an elliptical or circular - shaped scar and a thick base. These factors are important in eventual NAC reconstruction as thin flaps can potentially decrease nipple projection and poorly located scars can prohibit the use of certain flap techniques due to interference with blood supply.

Techniques of Nipple Reconstruction

Composite Nipple Graft

Initially described by Adams in 1944 and further developed by Millard in 1972, contralateral nipple grafts are a popular method for nipple reconstruction in patients with excess contralateral nipple projection (projection in excess of 5 - 6 mm). However, many patients have reservations about this method due to fear of contralateral surgery, donor - site morbidity, and decreased contralateral nipple sensation. Some patients decline to have surgery on the normal breast and NAC, and sharing is only used in selected cases such as hypertrophic contralateral nipple or thin skin coverage in an alloplastic breast reconstruction. Banked nipple grafts for replantation are an alternative but often lose pigmentation and produce variable aesthetic results.

Local Flaps

Local flaps for nipple reconstruction can be divided into three groups: centrally based flaps, subdermal pedicle, and pull - out / purse - string flap techniques. The main concern in nipple reconstruction is creating long - lasting projection. Centrally based flaps are subjected to greater retraction forces acting on the entire base of the flap, while subdermal pedicle flaps have reduced retraction forces as the major part of the flap is freed from the underlying tissue. All local flaps are subject to contraction to a variable degree, resulting in loss of flap volume and projection. Scarring or irradiation can significantly compromise blood supply and the final result of all flaps. Examples of local flap techniques include the star flap, which has the advantage of eliminating skin - graft donor - site morbidity but may lack projection.

Flaps with Autologous Graft Augmentation

This concept is introduced to overcome the common problem of late flattening after reconstruction with local flaps. Techniques include cartilage graft and fat graft. Auricular cartilage was first advocated by Brent and Bostwick in 1977 as a method to augment nipple reconstruction. Costal cartilage grafts have also been used, for example, in conjunction with the arrow flap in autologous breast reconstruction. Fat grafting has become an increasingly popular method as a surgical adjunct for soft - tissue augmentation in all aspects of plastic surgery and is also being used in nipple reconstruction.

Flaps with Alloplastic Augmentation

Alloplastic grafts are used for nipple reconstruction to provide stable projection. However, the main disadvantage is the risk of infection and extrusion. Fillers can bleed into surrounding tissue and may interfere with oncologic surveillance. Materials currently used include hyaluronic acid, calcium hydroxylapatite, and others. For example, Evans et al. used Radiesse™, injectable calcium hydroxylapatite embedded in a cellulose gel, to augment the reconstructed nipple and found that patients were satisfied with the results.

Flaps with Allograft Augmentation

Acellular dermal allografts, such as Alloderm™, have expanded to all aspects of revisional and secondary breast reconstruction, including nipple reconstruction. They have many of the ideal properties of an implantable material, with a high rate of incorporation and limited resorption. Nahabedian first used Alloderm™ for revisional nipple reconstruction in 2005, and subsequent studies have shown that it can help maintain nipple projection.

Areola Reconstruction

Skin Grafting

Skin grafting of the areola has the advantages of providing a textured, wrinkled surface and distinct pigment differences, similar to a normal areola with Montgomery tubercles. Common donor sites for areola skin grafting include the contralateral areola, inner thigh / groin region, revised / excess breast skin, or other body areas where revisional surgery is needed. To avoid a donor site, the planned areola can be elevated and raised as a skin graft and re - placed into its original position.

Tattooing

Tattooing is another major adjunct to areola reconstruction. It can be used alone or in conjunction with skin grafting to provide an excellent areolar color match with limited morbidity. It uses intradermal pigments, typically mixtures of iron and titanium oxide. In unilateral cases, colors should be chosen that are slightly more pigmented than the contralateral areola. After tattooing, the area will usually undergo sloughing and crusting for 3 - 5 days, and many patients will require touch - up tattooing after several months or years to achieve an aesthetically symmetric color match.

Patient Considerations for Areola and Nipple Reconstruction

Candidate Selection

Patients who are good candidates for areola and nipple reconstruction include those who have lost their nipples and areolas due to cancer excision, trauma, or congenital absence. Women who have had a mastectomy as part of breast cancer treatment often opt for this procedure to complete their breast reconstruction. Additionally, individuals with nipple - related problems such as inverted nipples or asymmetrical nipples may also be candidates for corrective and reconstructive procedures. However, patients should be in good overall health and have realistic expectations for the outcome of the surgery.

Recovery and Aftercare

After areola and nipple reconstruction, patients can expect some pain, numbness, and soreness around the incisions for a week or two. The surgeon will use a nipple shield or a protective dressing and may provide an antibacterial ointment to prevent infections. It is important to keep the dressing in place and clean for seven to 10 days or until directed to remove it. The reconstructed area takes about 10 days to heal fully. Patients should avoid tight bras and clothing over the nipple, take a shower two days after surgery while avoiding washing the surgery area, and avoid heavy lifting for several weeks until fully healed. Depending on the nature of their occupation, they may be able to return to work the next day, but should avoid strenuous tasks.

Cost and Insurance

The cost of areola and nipple reconstruction varies depending on the type of surgery technique used, the expertise of the surgeon, and the location of the institution. According to the Women’s Health and Cancer Rights Act of 1998 (WHCRA), insurance plans must cover the cost of breast reconstruction after a mastectomy and other reconstructive procedures. However, patients should work with their doctors and insurance providers to confirm whether their plan covers the specific procedure.

Conclusion

Areola and nipple reconstruction is a complex but rewarding procedure that can have a significant impact on the physical and emotional well - being of patients. In New York City, the top five institutions mentioned in this article offer high - quality services in this specialized field, with experienced surgeons and advanced techniques. Whether you are a patient considering areola and nipple reconstruction or a medical professional looking for more information, understanding the various techniques, general principles, and patient considerations is essential. If you or someone you know is interested in areola and nipple reconstruction, we encourage you to reach out to one of these top institutions for a consultation and take the first step towards a more confident and positive self - image.