Thank you for joining us today here. Today we are doing a completion of a breast reconstruction. This patient has had a previous breast reconstruction with implant and some fat grafting. Now, we are moving towards the final touches of the breast reconstruction. You can see that she had a previous tattooing in nipple, but it's not uncommon for patients to have that 15,20 years ago, and then the nipple completely deflates in terms of being flat not having any projection. So we are going to come in today. We are 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 times. So weathering the storm for a little bit is going to give you a lasting long term results, 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 other scars and incisions elsewhere on the body. We'll get started with this.

So here, place the incise in the outline of our flap that we used 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 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 of the surgeries that I talk to people about, this one with the tattooing 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 the implant, the fat grafting, or TRAM flap whatever they had initially.

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

I just begin this by just trying to close some of these donor sites so that we can bring all that tissue around together and really create a nice nipple that's going to be projecting for her. The nice thing about the way this is done is the scar's here. The incisions are all within what's going to be the new areola, and once she gets tattooed, the tattoo will be right over all of these incisions.

So now we've gotten the donor site closed which you can see is already pushing out our nipple and giving a nice kind of overall shape to the breast. Now we are going to bring all these little flaps together and start to really kind of make it look like a nipple overall. As you can see, we've got to finish closing up the rest of the donor site here, but we've already created the nipple that has projection, that has volume and then that will shrink down to about half of that to give her a nice nipple that, once we tattoo around, will cover up her other incisions and give...

So here, we can see we've completed our nipple reconstruction. On this side, we've sewn shut where we took the skin from. We've been able to cause projection, give a nice nipple there, as the swelling goes down, it will sit and shrink just like that, and we're set for a nice nipple, then we can come back and do the areola tattoo around it. Because she'd had some tattooing before, the nipple itself already have some projection and cause a nice nipple for her.

Watch a Live Nipple Reconstruction Using the Star Flap Technique

Dr. Johnny Franco introduces a patient who had previously underwent a breast reconstruction and now presents for nipple reconstruction.