When mastectomy is performed for breast cancer, conserving the nipple-areola complex (NAC) may not always be possible. The surgeon decides whether the NAC will be preserved or not, according to the type and location of the tumor and the accompanying symptoms.
Most of the time the breast reconstruction is performed simultaneously at the time of mastectomy. However, a staged approach is preferred if there is a risk regarding the vascularity of the tissues following mastectomy. Whichever method is preferred, NAC reconstruction is the final stage of the breast reconstruction journey. If the NAC cannot be preserved or it is lost due to complications following surgery, NAC reconstruction can be discussed with all breast cancer patients.
What is the ideal time for NAC reconstruction?
It is recommended at the earliest 3 months, preferably 6 months after breast reconstruction. The chemotherapy and radiotherapy sessions must be completed as well as the completion of the surgical process of the patient.
How is the NAC created?
NAC reconstruction is usually done by shaping the patient’s tissue. This procedure can be easily performed under local anesthesia at an outpatient clinic. Of course, it will not have a function and sensation, but it is possible to obtain a visual appearance that will please the patient. Medical pigmentation (medical tattooing) is recommended for patients to obtain a realistic appearance after nipple protrusion is achieved. NAC reconstruction along with pigmentation greatly increases the patient’s quality of life.
One of the recent developments in the field is the NAC implant. Like the breast implants we use for breast reconstruction, implants that can be easily placed under the skin have been designed for the nipple. This application can be easily performed under local anesthesia in the clinical setting. To obtain a realistic appearance, it is recommended to support this technique with medical pigmentation as well.
For people who do not want any surgical intervention or foreign material, medical pigmentation alone is a good alternative. Tattoo artists who specialize in this subject can create three-dimensional images of NAC by making use of shadow and light art theory. The session may need to be repeated from time to time due to the fading of the pigments over time.
Why do we recommend NAC reconstruction to our patients?
During the breast cancer journey, patients go through a very difficult process. Even if the breast mound reconstruction is done perfectly, the patient’s inability to see the nipple when she looks at her breast may always make her feel a lack. Nipple-areola reconstruction should be discussed with every breast cancer patient to increase the quality of life of the person in this process and to make her feel more complete in front of the mirror and her partner. Nipple reconstruction is also a step that symbolizes the end of the breast cancer treatment process.
Dr. Isil Akgun Demir
instagram: dr.isilakgundemir
