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Reconstruction: Revisions

  • 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 patient’s native nipple/areolar complex serves as a template. The Skate Flap Method is used for nipple/areolar reconstruction.

Nipple Reconstruction

  • Areolar Reconstruction

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 complex—typically 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 patient’s native nipple areolar complex to anticipate fading as the tattooed area heals.