WHY NIPPLES FLATTEN AFTER NIPPLE RECONSTRUCTION SURGERY

One of the least publicized aspects of breast reconstruction surgery after a mastectomy following breast cancer is that the nipple typically flattens within a couple of months, or even weeks after nipple reconstruction surgery. What “flattening” means is that the protrusion created by the surgeon during the nipple reconstruction usually shrinks, so that ultimately only a very small protrusion or no nipple protrusion remains on the breast mound. The nipple is considered “flat” – the end result may be a tattooed circle for an areola, but no discernable nipple projection.

In the medical community, including among reconstructive plastic surgeons, this flattening is considered to be the norm. It is viewed as a problematic, common occurrence without a distinct solution. In an attempt to counter this problem, plastic surgeons typically reconstruct the nipple to be as large as possible with the hope that in spite of the natural shrinkage a small protrusion will remain.

Contributing Factors

There are several reasons why flattening occurs, some of which are avoidable. Nipple flattening may occur as a result of one of these reasons, or a combination of a number of them.

The first reason that flattening may occur is from compressive forces placed on the nipple while it is healing. Compressive forces are anything that pushes on the nipple, such as a bra, a tight shirt, lying on your stomach or on your side, or even giving someone a hug. These compressive forces are things that occur normally throughout the day, and the accumulation of these forces adds up to quite a bit of time where the nipple is being compressed down into the breast mound. It can take a few months for the scarring to stabilize and the nipple to form, and during this time it is imperative that there are absolutely no compressive forces on the nipple.

The second reason that flattening may occur after nipple reconstructive surgery is due to tensile forces from the scarring and tissue contraction in the donor site area that are placed on the nipple after surgery. As the area surrounding the reconstructed nipple heals, it exerts pulling forces on the nipple. Alternatively stated, after the plastic surgeon sews the skin together from where he or she took the tissue to form the nipple, those scars lead directly to the nipple. As the tissue heals, the scars pull on it – retracting the nipple. When the nipple retracts, it is pulled flat into the breast mound.

The third contributing factor to nipple flattening may be due to the breast mound. In general, the more tissue that the surgeon has to work with on the breast mound to create the nipple, the larger a protrusion that can be made and the greater the probability of achieving some protrusion after the flattening process stabilizes. Also, if, for example, the breast mound is very tight on the thorax – meaning that there is not a lot of hang to the breast and the breast is not very mobile, the skin is often very tight. When the skin is tight, it makes it more difficult for the surgeon to create a nipple because there is less tissue available to create it. And, since skin and tissue is being taken away from the breast mound to make the nipple, when the donor skin site is sewn together, the skin and tissue on the breast mound can become even tighter, leading to strong tensile forces and nipple flattening as described above.

Asteame Medical Device’s Nipple Guard may mitigate or lesson the affect of the aforementioned three major contributing factors to reconstructed nipple flattening.

Lastly, a surgeon’s expertise, as well as the surgical technique used, can contribute to the amount of nipple flattening. There are different surgical techniques, and a number of things might determine which technique a surgeon uses. There could be circumstances surrounding your specific case that rule out using one, or indicate using another; and, sometimes each surgeon usually has one that he or she prefers. We recommend that you speak to your surgeon about how he or she plans to reconstruct your nipple.