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Hello, my name is Dr. Johnny Franco, and I'm here continuing our video series at Miami Plastic Surgery. Today we'll be doing a nipple reconstruction for a patient that's had breast reconstruction and a previous breast cancer.

While nipple reconstruction is a small finishing touch on the breast, it really makes a big difference for patients. As you'll see, it's a simple, quick procedure, but it really makes a huge difference in the overall appearance. It changes what is just a breast mound into a true breast with very little extra surgery. And so I think you'll be quite pleased with this, and I hope you enjoy the video.

Thank you for joining us today here. Today, we're doing a completion of a breast reconstruction. This patient's had a previous breast reconstruction with implant and some fat grafting. Now, we're moving towards the final touches of the breast reconstruction.

You can see that she'd had a previous tattooing in nipple, but it's not uncommon for patients to have had that 15, 20 years ago, and then the nipple completely deflates in terms of being flat, not having any projection. So we're going to come in today; we're going to create a nipple flap. This is called a star flap as you can kind of see by the shapes of it. You may be thinking that this is a little bit big for the actual nipple itself, but I typically make this at least twice the size because they all shrink down by about 50% over time. So weathering the storm for a little bit, it's going to give you a lasting, long-term result, so that hopefully, she doesn't have to do this again.

We'll cut this out and actually make a tactile nipple out of her own tissue, without having to do some of the methods that were done in the past, where we took skin grafts and different things from other parts of the body; this keeps everything on the breast, avoids any other scars and incisions elsewhere on the body. We'll get started with this.

So here, basically incising the outline of our flap that we'll use to create this nipple. This is actually one of my favorite operations because it's such a small finishing touch surgery, but really makes a huge difference for people. And they can do this really whenever it fits their time. A lot of times, after the initial breast reconstruction, they've had so much surgery, so much other stuff; they're just not really interested in doing this. And I'll tell you, of all the surgeries that I talk to people about, this one with the tattoo and the completion, really makes a big finishing difference for people because other than just being a breast mound, it really gives a center of focus to the breast, and really gives the breast something different than just a massive tissue that it can look like with either the implant, the fat grafting or TRAM flap, whatever they had initially.

In patients that sometimes don't have very much tissue, sometimes I'll use some other materials to help fill the projection. If they don't have a lot of soft tissue, someone like this who's been previously fat grafted or something else, tend to have a little bit more bulk and we can do that. We start by just lifting the entire flap, and then I'm going to show you how we can fold that and use that to create a nipple. I just want to be really gentle with the little tips of this flaps because they're thin and the tissue's thin, so you really don't want to cause any wound healing issues. And so I start thin and then try to get a little deeper to take out some of this other fatty tissue that's going to give us a little bit of volume to this nipple reconstruction.

This can be done in combination with other procedures, as this patient's having done today, or can be done alone with either under local or a little moderate sedation in the office. A lot of people who have had other breast reconstructions don't have a lot of sensation here, so they tend to tolerate the procedure really well or just in combination with another procedure.

So you can already kind of see here... so I'm able to lift up the flap, and then we're going to wrap it around to create a new nipple. Put a retractor on that, please. I'm just being gentle with the flap here. We're going to lift some of these other flaps so that we can get this closed and shrink. And the other thing that helps is kind of comb the tip of the breast to give this the most apex kind of portion of the breast.

If somebody has not had bilateral reconstruction, I would match this side to their natural nipple. In someone who's had a mastectomy on both sides, typically don't do that; we just make them both about the same size, and a size that is going to make the patient happy and they feel comfortable with. A lot of that depends on what size breast they have now and so forth.

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Nipple Reconstruction Following Breast Reconstruction

Many women are dissatisfied or embarrassed by the appearance of their nipples. Dr. Johnny Franco takes us into the operating room to demonstrate a nipple reconstruction on a patient after a breast reconstruction.

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