PHOTO CREDIT:  Photo to the left was by one of the RN’s at the hospital taken right before my nipple “birthday party” on February 1, 2012. Total breast reconstruction includes the creation of a new nipple and areola tattoo.  This minor surgical procedure, performed in a sterile procedure room, takes about an hour from start to finish.

Below are the steps in my nipple construction.  Your plastic surgeon (PS) may operate differently, but these are the steps my PS, Dr. James Ferlmann followed to create my new nipple. SPECIAL NOTE: If you are planning to have breast reconstruction following mastectomy, it is advisable to meet with your PS BEFORE your first surgery.  Your PS will photograph your God-given breast, nipple and areola so later when it is time for reconstruction, there is a visual record of it.  In my case, since I only had left breast mastectomy and reconstruction, my God-given breast etc. was right there handy for reference.

10 Steps to a Build a New Nipplewritten by Britta  McKenna as performed by Dr. James Ferlmann

Step One:  In a bathroom or other room with a mirror, patient locates where they instinctively feels the nipple ought to be and marks it with a sticker.

Step Two:  PS and patient look at marker and measure distance first from fixed point (sternum area bone to God-given nipple) then to where the marker is.  I was only 3mm off, but who wants to have cattywompus nipples anyway? My PS also had me close my eyes and point to where I thought my nipples should be.  I was dead on for my newly marked nipple, but way off on my real one…go figure!  Surgeon draws cut lines on breast (see Diagram below).

Step Three:  Enter procedure room and get prepped – sterile swab, draping, etc. My PS uses AlloDerm (treated cadaver skin) for the core of the nipple, so he dropped it in solution to reach proper hydration level prior to use. Part of the prep is to have a local anesthetic injected via syringe into the topical breast area to numb. The injections hurt a bit, so grit your teeth a bit for some stinging.

Step Four:  PS cuts along pre-drawn lines, just deep enough to recruit enough skin to make the nipple.

Step Five: PS pulls up the “flaps” created by cutting the skin and fashions into a nipple, leaving the center core hollow and available to host the alloderm (See drawing below where Dr. Ferlmann demonstrated with a gauze pad).

Step Six:  PS sutures skin together along incision sites.

Step Seven:  PS cuts AlloDerm piece to size and places it into the center space of the nipple, then sutures it into place.

Step Eight:  PS performs final closures.

Step Nine:  PS used a gauze eye patch as a padding, by cutting out the middle portion to allow the nipple to remain upright and in place.

Step Ten: Affix the gauze patch to breast and paper tape securely.  I was told not to get this wet for 48 hours and keep the gauze pad on for a week until I see him for a post-op check.

OTHER NOTES:  A nipple fashioned out of your skin remains alive and is fed by your body’s blood, so should retain a pinkish color.  If you have had radiation on your breast, your skin may be more difficult to use for this procedure.  Does it hurt?  The only part that hurt a bit for me was the local anesthetic shot.  The first few pricks were in areas where my nerves have been cut, but PS was very thorough and found some areas to inject where I still have feeling.  You’ll feel tugging when PS pulls on the sutures and a bit of pressure, but I was talking through the whole procedure and even popped up my head to take a look at progress every now and again.  I brought a compression bra with me to wear home that was from a previous breast surgery. It is soft and fastens in the front for easy dressing and is something I didn’t care if anything got on it. I also brought a zip sweatshirt so I didn’t have to pull anything over my head after the procedure.  I even drove myself home, so how about that!