A surgically created nipple will look similar to a natural nipple but will not have sensation or react to touch and temperature in the way that a natural nipple would. The new nipple is created using skin and fat from your reconstructed breast, a graft A piece of tissue that is moved surgically. from your other nipple, if large enough, or a graft A piece of tissue that is moved surgically. of skin from elsewhere on the body. This procedure can be done in the clinic setting or in the operating room.

There are many ways a nipple can be reconstructed surgically. Shown here is one method simplified into four steps.

Below is a photo example of surgically reconstructed nipples and areolae.

A surgically created nipple will look similar to a natural nipple but will not have sensation or react to touch and temperature in the way that a natural nipple would. The new nipple is created using skin and fat from your reconstructed breast, a graft A piece of tissue that is moved surgically. from your other nipple, if large enough, or a graft A piece of tissue that is moved surgically. of skin from elsewhere on the body. This procedure can be done in the clinic setting or in the operating room.

There are many ways a nipple can be reconstructed surgically. Shown here is one method simplified into four steps.

Below is a photo example of surgically reconstructed nipples and areolae.

In pedicled flap surgery, tissue remains connected to its blood supply and is tunneled underneath the skin to reach the chest.

The illustration below shows an example of pedicled flap surgery from the abdomen. This particular flap is called a TRAM flap (transverse rectus abdominis myocutaneous flap).

A Pedicled TRAM Flap

1. Uses lower abdominal skin, fat and ALL the rectus muscle (six pack muscle). Blood vessels used are beneath the rectus muscle.
2. Flap remains attached and is tunneled through the abdomen and chest.
3. Longer recovery, may have some abdominal muscle weakness.

Combined breast reconstruction uses implants and tissue from another part of the body to recreate the breast mound A reconstructed breast that appears like a natural breast in clothing. . The most common type of combined breast reconstruction uses one of the muscles of the back called the latissimus dorsi muscle.

The back muscle and a portion of skin and fat on top can be rotated onto the chest to create a breast mound A reconstructed breast that appears like a natural breast in clothing. . The muscle is rotated onto the chest through a tunnel in the armpit. This will create bulkiness under the arm that will decrease over time. An implant or tissue expander is placed underneath the lastissimus muscle because most women do not have enough fatty tissue on their back to recreate a sizeable breast.

If a tissue expander is placed at the time of the muscle flap, a second surgical procedure will be needed to exchange the expander for a long term implant. 

The scar will often be placed at or above the level of your bra line so that it remains hidden. Use of this muscle will not affect your ability to continue your regular activities but a select group of women (competitive swimmers, tennis players, rock climbers) may notice some shoulder weakness.

The illustration below demonstrates combined breast reconstruction using the latissimus dorsi muscle and a breast implant.

A surgically created nipple will look similar to a natural nipple but will not have sensation or react to touch and temperature in the way that a natural nipple would. The new nipple is created using skin and fat from your reconstructed breast, a graft A piece of tissue that is moved surgically. from your other nipple, if large enough, or a graft A piece of tissue that is moved surgically. of skin from elsewhere on the body. This procedure can be done in the clinic setting or in the operating room.

There are many ways a nipple can be reconstructed surgically. Shown here is one method simplified into four steps.

Below is a photo example of surgically reconstructed nipples and areolae.

A surgically created nipple will look similar to a natural nipple but will not have sensation or react to touch and temperature in the way that a natural nipple would. The new nipple is created using skin and fat from your reconstructed breast, a graft A piece of tissue that is moved surgically. from your other nipple, if large enough, or a graft A piece of tissue that is moved surgically. of skin from elsewhere on the body. This procedure can be done in the clinic setting or in the operating room.

There are many ways a nipple can be reconstructed surgically. Shown here is one method simplified into four steps.

Below is a photo example of surgically reconstructed nipples and areolae.