Monday, July 13, 2009 Connie Jackley asks

Q: Wondering about nipple reconstruction............

I have written before describing my ordeal - my double mastectomy on March 9th, my expander saline fills that lasted until first week of May, then finally my silicone implants on June 9th. Things went fairly well since the implants. My pain has been minimal, just the incision healing mostly and just like an aching feeling in each breast. I am really not happy about the huge incisions, but I suppose having the mastectomy leaves such scaring. When the implants were put in, my surgeon just cut the outer half of the breast to insert the implant versus the entire breast which was a plus. Now I am just waiting for my 3 month appointment in September at which time I will let my surgeon know what I have decided about the nipple/areola reconstruction. I just am not sure about it, and I was wondering what imput anyone out there may have with a similar situation as mine. No, it is certainly not a necessity. Now I do not even really need to wear a bra. I think my husband would love for me to do it??? Although there is not a whole lot of feeling there for me?? I never even thought I would EVER go through the whole expander, reconstruction process in the first place, but I made it through. I have always been a bit on the vain side and just could not see myself without any breasts for the rest of my days, even turning 60 next month. I just spent three days at the beach, and let me tell you how glad I was that I endured it all when I put on my bathing suit. Wow, just amazing to have these "Puppies" as my husband calls them at my age and feeling so confident wearing certain clothing. There IS a bright side to the horrible ordeal cancer is, and I have been through it many times. So now do I do the next step and subject myself to more procedures and more discomfort?? I just do not know what to do. Any comments would be greatly appreciated, although I know we are all different - - and the decision is mine.

Thanks and all the best to all of you fighting this horrible fight.

Connie J.

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Answers (5)

PJ Hamel, Health Guide

7/14/09 8:06am

Hi Connie - in my experience, the procedure is minimally invasive, and the pain level pretty low. You mention you're vain - well, go for it! Let me warn you these won't look like your natural nipples; I've never yet seen a plastic surgeon who could make them "just like new." But in clothes, you'll get the nipple effect. And your husband, as you say, may be happy those "puppies" have been finished off! Good luck - PJH

2 cancers

7/16/09 9:22am

I had new nipples made from a small procedure, not sure what he did but he did give me "bumps". After that I had tattoo nipples done. I asked to use three colors, since the nipple was darker for me, that was the dark color. The areola on me before was two colors one lighter than the other, so they did that.

I find for me, that I am sooooooo happy that I did that. When I pass the mirror after a shower, before my breast would catch my eye, something was missing. Now, I feel comfortable that I look normal. I don't regret it for a moment.

Connie Jackley

7/16/09 5:20pm

Thanks so much for your input. It is great to see what others have gone through. It amazes me about the different colors - I was not aware. You say you got "bumps" but obviously skin was taken from elsewhere on your body or you certainly would have been aware of that, for sure!!! My plastic surgeon only briefly described the procedure and seemed to think he could construct a nipple from my skin there now - - if I am remembering correctly!! The old memory is not as it used to be, and you know how we half remember things when in the doctor's office. I will discuss at length when I go back in September - but I loved your comments. I appreciate it and the best to you!!!

2 cancers

7/16/09 7:34pm

I am glad to help. The nipples were made from the skin on the breast.

jeanne

1/15/12 1:17pm

That procedure is what I am considering.. do you like them? Do they protrude though clothes or look un-natural? Any info you can give me would be greatly appreciated! I had a bi-lateral mastectomy so would be considering it for both implanted breasts.

Jeanne

kay

5/27/11 5:47pm

Thank you for sharing your thoughts, I sit here today crying because I can not decide on what to have done, 7 days until my surgery. Its people like you that take the time to sit and share your thoughts are the ones that help us through our tough time. God Bless You.

PJ Hamel, Health Guide

5/27/11 6:36pm

Kay, look deep into your heart, and try to feel what's best for YOU - without hearing all the opinions of your friends, doctors, etc. It's your body; and your decision. Once you come to a decision (and you will, never fear), don't look back; no recriminations, or "woulda, shoulda, coulda." You're doing the best you can with the information you have. And I have no doubt that what you eventually do will be the best decision. Please write back if you have any specific questions we can answer, OK? Take care- PJH

jeanne

1/15/12 1:15pm

I had my nipples tattoed on, and though I'm not unhappy with the look, I still don't have the feminine feel of having nipples. I'm considering an office procedure done where they take the skin and twist, (not a good candidate for more surgery than necessary) and then would it have it tattoed over that. Is this what you had done? and If so do you like how they turned out? I can't seem to find any pictures of them to at least get an idea. My PS has pictures of nipple reconstruction done from surgery, but not of the same skin to twist.

Thank you,

Jeanne

PJ Hamel, Health Guide

1/15/12 3:17pm

Jeanne, first of all I'd be a litle leery of a surgeon ho says s/he can perform a particular surgery, but doesn't have any pictures to show you. If s/he does it regularly; you'd think s/he'd have access to photos, right? If you can't see what the final result would be, how will you know if it's what you expect?

Aside from perhaps getting a second opinion from another surgeon - one who can show you pictures - I'd suggest Googling "nipple reconstruction twist skin." I just did that, and found quite a few pictures... Best of luck to you - PJH

llenox

7/16/09 10:38am

Hello Connie. I had a lumpectomy followed by chemo and radiation on my left breast in 1990. I had a new cancer in my left breast and under my right arm in 2006. For that I had a double mastectomy followed by chemo. Because of the radiation and scars from radiation burns, I had to have a flap from my back to close my mastectomy on the left side. The flap wasn't large enough to cover the entire area and scared skin below the left side died and had to be replaced with a skin graft. We tried hyperbarric treatments to force that tissue to heal, and it worked to a point, but not enough. I've had an expander on my right side and now have an implant. The left side cannot have an implant. The incision from the last surgery on my left side opened after the stitches were removed and had to be re-stitched. I have the option of having nipples made and decided against it. I was told that the nipples were formed by taking skin from the groin area and twisting it to make it look like nipples. Then it would still have to be tattooed to be the right color. The skin graft I've already had to have was more painful than the double mastectomy and I simply do not want any more surgery at this time. If I get a tattoo at all, I want something pretty on my arm! I'm 60 years old and my husband said it was my decision and that he was ok with whatever I decide. I have thought of drawing happy faces where nipples used to be! Bottom line? Radiation sux. It does not prevent a new cancer, even 18 years later. Radiated skin does not heal, ever.

Connie Jackley

7/16/09 5:29pm

I am so very sorry for your ordeal. Our daughter had radiation to her head, and I definetly know what you mean about the healing process with radiated skin - and no, it did not help her either. I am sorry you went through all of that and the cancer returned. I am just taking my chances with no treatments, as I had done with my other surgeries. Right or wrong? Who is to say - but you certainly had an ordeal with your left side. I can certainly see why you would not want to subject yourself to more skin grafting, etc. At our age, does it really matter to have the whole process done? That is what I ask myself, but lucky for me I was able to have both implants done. Yes, in the end it is our decision and my husband certainly will not make up my mind for me, but he is still encouraging me. I think cause he knows me very well and thinks I will be happier if I finish off the whole procedure??? I love your thought about the happy faces!! It is good to see we can still have a sense of humor through it all. Best of luck to you and prayers that cancer will not darken your door again.

Connie

7/19/09 11:43am

Hey connie, it's connie! I had bilateral mastectomies with an implant on the left side and a tram flap on the cancer side due to severe radiation burns. my plastic surgeon did an excellent job, and when discussing nipple reconstruction, he said they take the skin from the inner thigh up by groin or they can take part of your labia and make nipples. the down side is that he told me they almost always go flat after a few years. I opted not to have them put back on because of that. I am considering having rosebuds tatooed with a pink center. hope this helps! Connie

Connie Jackley

7/21/09 7:47pm

Ouch!! Taking skin from inner thigh or labia - - no no I do not think so!! Thanks so much for the info - I have not heard about the flattening in a few years. That would be a bummer, especially after going through all of that. I am more and more leaning towards leaving things as they are and not subjecting myself to more misery. I know someone else told me they used the skin on her breast, and I thought I remembered that was what my surgeon mentioned, but I will not know for sure until he sees me in September. The rosebuds sound very nice!! How are your scars - across your entire breast and in the middle? No one has really mentioned that to me, and I was wondering. Of course, mine have not faded much since I only had my double mastectomy in March. The implants just reopened the outer edge, but it is really feeling pretty comfortable AND I can finally sleep without fear of laying or rolling on the implant!!! So hey, Connie, (are you Constance also) - thanks for the reply and best of luck to you.

Connie J.

PJ Hamel, Health Guide

7/21/09 8:04pm

Hi Connie - I've had my reconstructed nipple for 8 years and it's not flat yet! So I guess some of them hang in there... It wasn't huge to begin with, just a nice little bump. And yes, it was made from my breast skin - they just cut a slit, and somehow lapped some over on itself. I was awake, but Valium-d - so wasn't really paying attention, except the surgeon and nurse were talking about their favorite flavors of ice cream, so I got to thinking about that... Good luck in September! PJH

Connie Jackley

7/21/09 8:13pm

Thanks, PJ - I know you mentioned previously the procedure was minimally invasive with little pain. It is really nice to know that you did not have the experience of the flattening. It is ALSO great to hear that maybe I DID hear him correctly when he said he would use my breast skin. Could you tell me about your scars while we are chatting?? Have they faded allot after 8 years - oh wait, I think you just had one breast done if I remember correctly? Have you used any of the scar creams to fade the scar or what is your opinion on those creams? My surgeon mentioned that they may make a slight difference for some people but not for everyone. They are just really ugly at this point, but I know it is still early. Thanks so much.

Connie

PJ Hamel, Health Guide

7/21/09 9:33pm

Connie, I had a skin-sparing mastectomy and tram flap reconstruction. Luckily, my only scar is a 2" circle right around my reconstructed nipple. It's not very noticeable, and has faded over time... It's quite nice, really. I wish you well with your healing - PJH

Gailbaby

7/27/09 6:18pm

Hello, I had cancer in my left breast. went for double mastectomies and reconstruction May 15, 2008. Had the nippling done in Sept 2008, my Dr used a technique called" modified skate flap." Looks great ,minimal pain, then tattooed areola on in December 2008. I am doing treat and my TA TA's look wonderful and I am cancer free !!

Connie Jackley

7/29/09 8:24pm

Thanks so much for your reply. I am so happy for you that you are cancer free AND love your TA TA'S - too cute!!! It really helps to see yet another lady happy that she went through the whole procedure to achieve the complete result. I must admit, I am now leaning towards going ahead with it. I do not know what a "modified skate flap" is - - would you be able to explain it?? As I said, I thought my surgeon mentioned just using the breast skin - but maybe that may change when he sees me in September. Thanks again!!

Connie

Gailbaby

7/29/09 10:34pm

As described by Dr Yoak, the "modified skate flap" is an incision on the breast almost in the shape of a Chevrolet insignia with the bottom part not on it. it is two parallel incisions. the bottom incision is about 2 inches long with an uncut space in the middle, the top is equal length, with a upwards flap , like an upside down "u" in the middle. the space between the two lines is probably a quarter of an inch and the ends of this space is cut, hence the "flap. Then the "flap' is raised up, the top flap on the incision is turned down and the two "wings' are wrapped around it and all stitched to and around it and the remaining side incisions are stitched. I had no after pain at all, I do not have any feelings in the skin yet. but that is OK. I healed wonderfully and almost did not get the tattooing, but realised I was doing this to feel like a girl again and so I did it and do not regret any decision I made, The tattooing did not hurt either, no feelings. I can show you a picture if you want to email me at ghair66@duddenlink.net. I do not want to post it here. Hope this all makes since.

Connie Jackley

9/ 6/09 9:41pm

Hi There:

I have tried several times to email you at the address you gave me telling you that I would love to see the pictures you mentioned, but each time I got a notice that the mail was undeliverable. So, I am just trying to get through to you now, through the network. My mail address is connie.jackl@verizon.net if you get this message and are still interested in sending me the photos. I would really appreciate it. I am still contemplating what to do, but will wait and talk to my surgeon on the 30th. So far things are OK and hoping it stays that way. Hope all is well with you.

Thanks

Connie J.

Gailbaby

9/ 7/09 1:54am

Sorry about that, I mistyped my address, I sent you the pictures of nipple reconstructuon after the stitches were out and the tattoing after the nippling had healed. I hope they are clear enough for you to understand how the nippling was accpmplished. God Bless, Gail

Q: Wondering about nipple reconstruction............

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