If a nipple graft fails could it be fixed by doing a nipple transplant?

Question

If a nipple graft fails could it be fixed by doing a nipple transplant? I've heard of reconstruction and tattooing, but could a transplant be possible?

Richard H. Tholen, MD, FACS · Answer

I assume you mean a transplant from a cadaver donor, as I think it would be hard to find a living patient who would be willing to give up one of her own nipples!Yet, this is a reasonable question since we have kidney, liver, heart, and many other organs that are donated and transplanted every day, so why not nipples?The answer is that use of someone else's tissues always causes rejection by the recipient (unless the donor is an identical twin), and why careful matching to reduce the rejection response severity is required--along with powerful anti-rejection drugs that themselves have side effects.So, for a kidney, heart, and now even hands and faces, matching and powerful drugs are acceptable trade-offs. But not for a nipple.Besides, if a person's nipple-areola graft fails, that patient has ample other options for nipple reconstruction, just as we do for our breast cancer patients. These options are pretty good, but not quite as good as "original equipment!"So if you're a candidate for nipple areola grafting with your top surgery, avoid any nicotine use or exposure to second hand smoke, and follow your surgeon's rules. Your risk of graft loss is in the low single digits. If you smoke (even one cigarette), use nicotine any other way (vape or e-cig), or are exposed to second-hand smoke, why risk the increased chance of graft loss (could be as high as 15-20%)?Thanks for the great question. I hope my answer clears that up adequately! Cheers! Dr. Tholen

Chris Porter, MD · Answer

This would not be suitable as transplanted skin from another person is highly immunogenic and will be rejected within 2-3 weeks unless you are on anti-rejection drugs. This is not wise as these powerful drugs expose you to a good deal of complications. The best option for a failed nipple graft is 3D tattooing or a nipple reconstruction plus tattooing.

Sheldon Lincenberg, MD · Answer

Tissue that simulates a nipple can be transplanted from elsewhere on your body such as  tip of the earlobe or toe. Transplanted tissue from another person is only successful if it is from your genetically identical twin.

Emese Kalnoki, MD · Answer

Thank you for your question.  There are a number of techniques that can be used if a nipple/areola graft fails.  Most often, however, the graft does not completely die off, meaning there is still some areas of color and projection after the surgery.  In these cases, tattooing the area that has lost color can be done.  If necessary, some areola from the opposite breast can be taken to use as a graft (this gives the best color match).  Grafting from a cadaver is not a great option since rejection would likely occur and the graft will die.  To add back projection to a nipple that has flattened out after surgery is a little more difficult.  Options of fillers, fat grafting, and placement of acellular dermal matrix may be used.  Hope this helps!

If a nipple graft fails could it be fixed by doing a nipple transplant?

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