The nipple is usually created during a separate operation three months after the microsurgical transfer of tissue procedure. The advantage of waiting to create the nipple is improved blood flow to the transferred tissue and possibly improved cosmetic result because time allows the breast reconstruction to settle and swelling to diminish. The procedure is done as an ambulatory procedure with the patient going home later in the day.
The nipple is created by spiraling two small flaps of skin from the breast reconstruction. During this procedure, surgical revision to the breast reconstruction can be performed to fine-tune the result. Also, revisions to the donor site can be performed to fine-tune the contour of the abdomen, buttock, thigh, or lateral chest/back.
The areola is tatooed by a professional medical tatoo artist during a separate visit to the office six weeks after the nipple reconstruction. The medical tatoo artist works with you to choose the size and color shading.