During Breast Reconstruction is it Normal to do the Nipples the Same Time as the Implants?

My ps does the nipples at the same time of the exchange surgery, from the expanders to the silicone implants. Is this ok? I know my surgeon has a great reputation, but I've heard most Dr's do the nipples at another time. What are your feelings on this? And what input do I have as far as the ending results of the size and shape of the nipples? Meaning, is this totally in the Dr's hands?

Doctor Answers 5

Nipples and breast reconstruction

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Yes, it is possible to do the nipple at the same time as the implants but I do not recommend it. After pocket work, it takes time for the implants to settle and take shape. Only then, is it a good time to proceed with nipple reconstruction. If the nipples are done too soon, then when the implants settle, the nipples end up being in the wrong place. That's not a good situation to be in because it can be hard to fix.

I hope this helps. I wish you well.

Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

No right answer, but...

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Hi there-

It is certainly possible to reconstruct the nipple at the same time as the implant placement, but in my opinion  this is much more likely to result in asymmetry or a result you are not pleased with. 

After your implants go in, there will be a period during which your outcome will "evolve", with your breasts changing in subtle ways. My preference would be to not put the nipples on until this has occurred.

Nipple reconstruction

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It is certainly true that some plastic surgeons prefer to perform nipple reconstruction at the same time as the implant placement is done.  I think most choose to wait until the patient has healed from the implant surgery.  My preference is wait three months before performing the nipple reconstruction.  I think this allows me to obtain more symmetric results.  Since I usually do the nipple procedures in the operating room, it also gives me the opportunity to revise any unsatisfactory results of the prior surgery.  There really is no right way or wrong way though.  It's more just a matter of preference.

Kelly Gallego, MD, FACS
Yuba City Plastic Surgeon

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Nipple reconstruction timing

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Personally, I would do the nipples at the very end, once all is stable, settled and healed.  The reason is that a symmetrical nipple can minimize the differences that are invariably present between the sides in breast reconstruction.  On the other hand, a very symmetrical mound reconstruction can be ruined by an asymmetrical nipple reconstruction.  If the breast mounds are still evolving, doing the nipple too early can lead them to move into an asymmetrical look.  Why rush it?

Timing of nipple reconstruction.

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The timing of the nipple reconstruction varies among surgeons. In cases of radiation or significant alteration of the capsule is performed, I prefer to delay the nipple reconstruction to avoid any unnecessary risk to the underlying exchange. However, if the exchange is straightforward and there is minimal manipulation of the underlying capsule or skin flaps, then nipple reconstruction can be performed safely.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.