- Tram Flap Revisions/Contouring
Approximately four to six months after initial
reconstruction, the TRAM flap may require contouring
revisions. These revisions may be performed by direct
excision of tissue or by using liposuction to contour
the breast mound. Nipple/areolar reconstruction may
be performed at the same time.
- Nipple/Areolar Reconstruction
The nipple/areolar reconstruction can be performed
under local anesthetic since sensation from the
breast mound is either entirely absent or diminished.
Multiple techniques are available for reconstruction
of the nipple and areola. The patients native
nipple/areolar complex serves as a template. The Skate
Flap Method is used for nipple/areolar
To reconstruct the areola, a full thickness skin
graft is harvested from the non-hair bearing inguinal
crease. The area surrounding the reconstructed nipple
site is deepithelialized to match the areola on the
native breast. The skin graft is placed over the raw
surface to reconstruct the areola. A running 5-0
plain suture is used to secure the skin to the graft.
Once the skin graft is secured, the entire
reconstructed nipple/areolar complex is covered with
a xeroform bolster. The bolster is held in position
using multiple 2-0 nylon sutures, placed
cirumferencially around the nipple/areolar
complextypically 6 sutures are used. The
bolster is removed five days after surgery. The skin
graft will darken with time.
- Nipple/Areola Pigmentation
Approximately four to six months after
nipple/areolar reconstruction, the patient may have
the area tattooed to match the color of her native
breast. (The Permark tattooing system is used.) The
initial tattooing should be performed with a color
several shades darker than the patients native
nipple areolar complex to anticipate fading as the
tattooed area heals.
© 1997 - TRANSMED