Surgery to the nipple areolar complex (NAC) is done for both reconstructive and cosmetic reasons. Reconstructive NAC surgery includes NAC reconstruction post-breast cancer surgery and correction of inverted nipples, while cosmetic NAC surgery includes both nipple and areola reduction. In general, any surgery done on a native NAC can affect a woman's ability to breast feed, will leave scars (although often subtle), and can alter the sensitivity and feeling in the NAC.
Women who have had a breast removed due to cancer and had subsequent reconstruction to make a new breast mound can have a new NAC created under local anesthetic 3-6 months after the breast reconstruction surgery. This is a minor procedure which usually involves making incisions on the center of the breast mound and rearranging the local skin to make a new nipple. Once the nipple has healed, the nipple and areola can be tattooed 6 weeks later to recreate the natural pigment. Although reconstructing and tattooing the NAC is a small part of the overall breast cancer surgery and reconstruction that many women go through, it can have profound psychological benefits by making the women feel "complete" again. Patients with thin skin over an implant reconstruction or with significant radiation-related skin changes may not be a candidate for NAC reconstruction.
Women who are born with inverted nipples (nipples that are tethered inward on the areola) can have it corrected with a minor procedure done under local anesthetic with minimal down time.
Women who feel their areola is too large may be a candidate for areola reduction surgery. This can be done under local or general anesthetic and will leave a circumferential scar around the areola.
Women who feel that their nipple projects too much, either naturally or after breast feeding, may be a candidate for nipple reduction surgery, which can be done under local anesthetic. Both nipple and areola reduction surgery are considered cosmetic procedures and so are not insured by the Medical Services Plan.