WHY NIPPLES FLATTEN

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.

Even reconstructive plastic surgeons consider flattening 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 forces adds up over time and result in the nipple being compressed into the breast mound.

The second reason that flattening may occur  is due to pulling forces on the nipple originating from the stitched area of the skin from which the nipple was formed. As the donar tissue area heals, the resulting scars retract the nipple; pulling the nipple flat into the breast mound.

The third contributing factor to flattening is due to tightness in the breast mound. In general, the more tissue that a surgeon has to work with on the breast mound, the larger the protrusion that can be made and the greater the probability of achieving some protrusion after the scarring process stabilizes.

Countermeasures

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

Additionally, a surgeon’s expertise and surgical technique greatly contribute to the nipple size that is originally achieved and to the size that is retained. We recommend that you speak to your surgeon about how he or she plans to reconstruct your nipple.