Prophylacti bilateral mastectomy in 2008 with nipple reconstruction using c-v flap. They are flattened. I have tried injectable filler Radiesse... with barely noticeable results. Is it possible to re-do and result in more palpable projection? I have also considered trying a product called Nipplettes, which is mostly for inverted nipples. Mine are a different situation and involve scar tissue. Thanks for any help and options.
How Can I Get Projection for Reconstructed Nipples?
Doctor Answers (11)
Projection of nipples after reconstruction
i have used a dermal substitute called alloderm to help give projection to my c-v flaps. I find this to work remarkeably well in patients who have undergone tissue expansion, which will naturally thin the overlying skin.
I wish you a safe recovery.
Nipple Projection after Breast Reconstruction
It can be very difficult to achieve satisfactory nipple projection with implant reconstruction. There are a few technique with which I have had success. First, revision with a different technique can often help. Also using dermal or cartilage graft can also improve the volume.
Projection of reconstructed nipples
You have identified one of the limitations we have in breast reconstruction with implants. Because your mastectomy skin envelopes are thin, it is challenging to maintain the projection of your reconstructed nipple given the thinness of the remaining tissue. I routinely add AlloDerm to my nipple reconstructions to help maintain their projection. But I always prepare patients with implant reconstruction that your reconstructed nipples will definitely shrink down.
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Poor nipple projection can oftern be e problem in implant reconstructions. One option is to add alloderm to the nipple reconstruction to help proved additional projection.
Alloderm for nipple projection
Unfortunately, nipple projection can deteriorate over time. I use alloderm to help increase projection for secondary nipple procedures
Help for Flat Nipples after Breast Reconstruction
The C-V flap nipple reconsrtruction technique you mentioned usually gives good results. In your case cartilage grafts from the ear may be helpful to improve nipple projection.
It is normal to lose some degree of nipple projection over time. I routinely use allograft (Alloderm) to give more volume and projection. Nipple reconstruction can be revised with placement of Alloderm, cartilage or dermal fat graft to give more projection.
Nipple projection is difficult to maintain
I like to use C-V flaps for my nipple designs, and usually do a technique to deepithelialize (or remove the outer layer of skin) a semi-circle where I sit the nipple down against the breast, so it is less likely to retract. Using Alloderm can be helpful, although the introduction of foreign material may slightly increase the risk of infection. Also, Alloderm grafts can sometimes become exposed or extrude. Similarly, silicone nipple plugs and other foreign body devices designed to achieve projection may carry prohibitive risks in some patients. I find the hardest patient to maintain projection is one who has undergone tissue expansion and had a thin mastectomy skin flap to begin with. There are even some patients for whom I can not offer a nipple reconstruction unless they are candidates for nipple sharing, which involves taking part of the other, uninvolved, intact nipple and grafting it to the reconstructed side. This is obviously not possible in patients who have had bilateral mastectomies without nipple sparing. Patients who are poor candidates for nipple flaps can still usually have nipple-areaolar tattooing.
The most interesting facet of nipple projection to me is the sociologic one: most women do not want their nipples to project through their clothing, making a projected reconstruction less important to some patients (often older ones), whereas the disrobed patient often feels less reconstructed if they have a flat nipple or only a tattoo... This is a major reason I do not think prosthetic onlay nipples (for example, silicone "pasties") have much of a market for the reconstructed patient population.
Projecting reconstructed nipples
Creating adequately projecting reconstructed nipples can be difficult. In some situations a graft (earlobes and even toes) may be used.
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