Reconstruction of the areola
In comparison with reconstruction of the nipple, reconstruction of the areola is relatively simple, although several different methods are also available here.
The techniques can be basically divided into 3 groups:
1. Conserving or “banking” the areola for subsequent transfer to the reconstructed site
2. Dermabrasion and spontaneous healing or split-skin excision and free skin grafts
3.Split or full skin transplantation
4. Micropigmentation the areola region
Loss of pigment and texture often occur with areola banking. For this reason this method is not usually used today. In addition there are concerns from the oncological point of view.
Dermabrasion, which can lead to changes in skin pigmentation, can in certain circumstances be used for patients with darker coloured skin, as darker pigmentation changes usually occur.
The preferred donor site for free transplants remains the contralateral large areola, which is reduced in size during a mastopexy or nipple reconstruction. The graft is dissected as a deep split-skin graft from the periphery of the enlarged areola and laid around the reconstructed nipple so that a single circular scar results. Other techniques of “areola sharing” should no longer be used today. Split-skin grafts from the surface of the donor areola and techniques which produce a spiral-shaped or other inadequate scar pattern on the reconstructed areola appear unnatural and no longer meet today’s aesthetic demands.
If there is no enlarged contralateral areola and therefore this region is not available as a donor site, the area of the groin is also a donor region for a full skin transplant for areola reconstruction. However, the transplanted areola is frequently so much altered by de-pigmentation that micropigmentation is required.
For this reason micropigmentation is almost exclusively carried out primarily world-wide, making skin grafting for areola reconstruction no longer necessary. This has the advantage that no unnatural, sharply-defined peri-areola scars are caused. Micropigmentation also allows natural fading of the pigmentation from the areola into the surrounding skin of the breast to be achieved. In addition, the nipple can be optically enlarged by darker pigmentation than the surrounding areola. However, in most cases micropigmentation has to be carried out several times in order to produce a permanent result.
Reconstruction of the nipple-areola complex is an integral component and a valuable detail of breast reconstruction, whereby the symmetry of the position of the nipple and the size of the areola should always be attained for an aesthetically pleasing and symmetrical over all result.