Techniques used for nipple reconstruction surgery have evolved over the years, many of which now include the use of fillers and tissue-regenerative biologic matrixes. The reconstruction technique chosen, however, largely depends on the expertise of the surgeon and the specific cosmetic needs of the patient.
RECONSTRUCTION OPTIONS Historically, nipple reconstruction has been challenging to perform. Surgical approaches range from skin grafting using tissue from the contralateral nipple, labia minora, pulp of the toe and earlobe with subsequent micropigmentation to color-match tissues, to more sophisticated techniques involving various kinds of pedicle flaps as well as fat grafting. All of these approaches can achieve good but varying aesthetic outcomes, and many are often combined in order to achieve the most optimal aesthetic result.
Hyaluronic acid fillers and biologic matrixes are much newer modalities that can be used in nipple reconstruction, either alone or in combination with other techniques. Just as patients' aesthetic goals can differ from one another, however, so do the preferred reconstruction approaches chosen by surgeons.
Should a given pedicle flap technique fall short of the patient's aesthetic goal, fillers such as Restylane (hyaluronic acid, Medicis) or Perlane (hyaluronic acid, Medicis) can supplement nipple rigidity and bolster surgically improved nipple projection. Ideally, filler treatment should be done in stages and injected gradually and progressively over time in order to better fine-tune the aesthetic result desired by the patient. Though the longevity of aesthetic outcomes may vary with fillers, Dr. Carraway says he believes that because the reconstructed nipple area is a relatively static region with a diminished blood supply, aesthetic results could last for years.