Had nipple sparing bilateral mastectomy. One nipple went half necrotic and fell off. What to do? (Photo)

Creating nipple is a relatively simple and routine procedure after mastectomy. This can be done with local in the office
i would consider any tattoo after the nipple is created. IMO...

The Naked Surgeon:

Plastic Surgery, The Naked Truth about Nipple Correction

To begin with, many women refer to the part of the breast with the Areola and Nipple as “The Nipple”. Let’s discuss anatomy for a moment. The nipple is the part that generally protrudes out from the center of what is actually the Areola. The Areola is the larger pigmented, generally round area usually centered on the breast. The pigment and shape can vary depending on ethnicity, genetics, pregnancy and so forth. The areola can be extremely pale and the edge hard to distinguish from the rest of the breast skin. On the other hand, it can be large, very dark and even elevated from the skin as a small “cap”. There may also be small bumps on the areola called Montgomery tubercles. These can enlarge with pregnancy, breast feeding or periods.

There are a variety of surgical and non-surgical treatments for each of these anatomic breast parts. Nipple correction is often requested for correction of inversion, repair from piercings or traumatic injuries, reduction of an overly wide or projecting nipple or enlargement for nipples that are not projecting enough.

Areola correction is generally requested for areolas that are asymmetric, too large, or too projecting. Overly projecting areolas are commonly seen in patients who have a tuberous or tubular breast condition.

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Most of these procedures can be done in the office under local anesthesia with minimal or no down time and quick healing. All of these procedures may interfere with breast feeding, or change and diminish sensation, so this must be considered by the patient before proceeding with a procedure.

Nipple Reduction

Correction of protruding nipples and correction of inverted nipples (ones that actually are “retracted “into the areola are the two most commonly requested procedures. Of interest is that Nipple Correction is frequently request by men as well. Overly projecting nipples may be too visible even with clothing in place. For men these may be too visible even in a t-shirt or tank top. Obviously, these can be covered with band-aides or nipple covers or “shields” easily available in many stores and even on-line.

It is also possible that the nipple is too wide in diameter, or even a combination of too wide and too protruding can exist. We have seen patients for Nipple Correction in Newport Beach, and Orange County for more than twenty years and it has been a consistently requested procedure during that time. Nipple Augmentation particularly with injectable products such as Juvéderm seem to more commonly follow social and fashion trends. Injectable Nipple Augmentation is a very simple and quick treatment that can be reversed if the patient finds that it doesn’t achieve their desired goal.

Nipple Augmentation

Surgical Nipple Reduction

This is a very simple outpatient treatment that can be done in the office with local anesthetic. It is very quick and heals in a few days with little down time from daily activities. Dissolving sutures are used and the aftercare is quite simple. Pain is generally managed with Tylenol or Advil. Non-surgical nipple reduction options are discussed above.



These treatments can be found on our YouTube link channel or Pacific Center for Plastic Surgery web site add link

Inverted Nipple Correction

This is a surprising common problem for women, seen in as many as 2% of adult females. This can be bilateral or may occur only on one side. This interferes with the ability to breast feed. It is also a source of embarrassment for many post-adolescent women especially with current trends in social media allowing the viewing of other women to be readily accessible.

For some women, the nipple can be pushed out or may come out naturally with cold as the Areola contracts. This can occur with adolescent breast development, after breast feeding, trauma or a growth in the breast tissue.

Surgical Correction of inverted nipples is also a simple operation for most women that can be done in the office as a brief procedure with local anesthesia. It requires very small incisions that generally become invisible. Although the breast ducts are frequently affected by the surgery, we use techniques of duct sparing surgery that provides a greater chance to preserve some duct function and sensation. It is common to perform inverted nipple surgery at the same time as another breast operation such as breast augmentation, mastopexy, breast reduction or breast revision surgery.

Again, when deciding to have the surgery, our patients must accept the possibility that the ducts will not work and allow breast feeding. They will also have a high risk of diminished sensation. That being said, the majority of our patients are overwhelmingly happy to have the correction of their nipples.

Non-surgical inverted nipple correction is best accomplished with a device such as the Phillips AVENT Niplette. This is a device, shaped like a thimble that attaches to the nipple with a small amount of suction, pulling the nipple out of its inverted position.



Areola reduction

The areola may be enlarged with breast development. Conditions such as tuberous breasts frequently have larger areolas. This can also be seen with large breasts, weight gain, asymmetries, pregnancy, and breast feeding.

The reduction generally requires a periareola or “donut-type” excision. Again, this can be done with local anesthetic in the office. There will initially be some irregularity of the incision with puckering that smoothes over 4 or 5 months. This is the same procedure used for the periareola breast lift or mastopexy.

Nipple surgery and Areola Surgery for Men

Both women and men may have “puffy nipples” which will require tightening the areola and sometimes removal of breast tissue from underneath the nipple. Men can also suffer from enlarged or inverted nipples which can be reduced in a similar manner to what has been discussed above.

Your particular case is definitely challenging and unfortunately there is no 1 good answer as to what to do in this case. I do not believe 1 surgery alone would correct your left nipple seeing as you would need tissue and some volume in the area. I think you would need to release the scarred tissue and then fat graft the area to help bring the tissue up and out. Next you need to figure a way to recruit skin to the area to correct the deficiency. Areolar tattooing is definitely a good option to consider too, in fact that is my preferred nipple/areolar reconstruction option for patients.