Editing Breast reconstruction (section)

==Adjunctive procedures==
To restore the appearance of the pre-operative breast, there are a few options regarding the nipple-areolar complex (NAC):
* A [[nipple prosthesis]] can be used to restore the appearance of the reconstructed breast. Impressions can be made and photographs can be used to accurately replace the nipple lost with some types of mastectomies. This can be instrumental in restoring the psychological well-being of the breast cancer survivor. The same process can be used to replicate the remaining nipple in cases of a single mastectomy. Ideally, a prosthesis is made around the time of the mastectomy and it can be used just weeks after the surgery.<ref>{{cite journal | vauthors = Ward CM | title = The uses of external nipple-areola prostheses following reconstruction of a breast mound after mastectomy | journal = British Journal of Plastic Surgery | volume = 38 | issue = 1 | pages = 51–54 | date = January 1985 | pmid = 3967113 | doi = 10.1016/0007-1226(85)90087-6 }}</ref>
* Nipple-areolar complex reconstruction can also be performed surgically.  Within the first year following breast reconstruction, flaps can undergo contraction and decrease in size by up to 50%.<ref name=":2" />  Although flaps are made larger initially for this reason, it is hard to accurately predict the final breast volume.<ref name=":2" />  Because of this, NAC reconstruction is considered the very last stage of breast reconstruction, delayed until after breast mound reconstruction is completed (including additional procedures such as fat grafting or excess tissue removal) so that the positioning of the NAC can be planned precisely.<ref name=":2" />  There are several methods of reconstructing the nipple-areolar complex:
** '''Nipple grafting (nipple sharing):''' If a patient undergoes a single mastectomy with reconstruction and the opposite breast is preserved, then one option is to remove part of the preserved nipple and transfer it to the reconstructed breast.  This also requires that the patient has sufficient nipple-areolar tissue to be removed as nipple grafting will decrease the native nipple's projection by about 50%.<ref name=":4">{{cite journal | vauthors = Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti MA, Roviello F, D'Aniello C, Nisi G | display-authors = 6 | title = Nipple-areola complex reconstruction techniques: A literature review | journal = European Journal of Surgical Oncology | volume = 42 | issue = 4 | pages = 441–465 | date = April 2016 | pmid = 26868167 | doi = 10.1016/j.ejso.2016.01.003 }}</ref>  One of the benefits of this procedure is that the color and texture of the NAC is identical to that of the opposite breast.<ref name=":4" />
** '''Local tissue flaps:''' For patients who have undergone bilateral mastectomies (as well as patients receiving a unilateral mastectomy who do not want to pursue nipple grafting), a nipple can be created by raising a small, local flap in the target area and producing a raised mound of skin very similar in shape to a nipple.  To create an areola, a circular incision may be made around the new nipple and sutured back again.  While this option does produce the shape and outline of the NAC, it does not affect the skin color.  To make it appear more natural, the nipple and areolar region may then be [[Medical tattoo#Paramedical tattoos|tattooed]] to produce a darker skin color more similar to a natural nipple and areola.<ref name=":3" />
** '''Local tissue flaps, with [[acellular dermis]] graft:''' As above, a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. A graft of acellular dermis (such as cadaver-derived material) can then be inserted into the core of the new nipple acting as a support which may help maintain the projection of the nipple for a longer time.<ref name="PRS1">{{cite journal | vauthors = Garramone CE, Lam B | title = Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection | journal = Plastic and Reconstructive Surgery | volume = 119 | issue = 6 | pages = 1663–1668 | date = May 2007 | pmid = 17440338 | doi = 10.1097/01.prs.0000258831.38615.80 | s2cid = 12604613 }}</ref>
*The nipple and areolar region may be tattooed later.<ref name="PRS1" /> There are, however, some important issues in relation to NAC tattooing that should be considered prior to opting for tattooing, such as the choice of pigments and equipment used for the procedure.<ref>{{cite web | url = http://www.cosmetictattoo.org/article/3d-nipple-tattooing-a-new-service.html | vauthors = Darby A | title = 3D Nipple Tattooing a New Service? | work = CosmeticTattoo.org Educational Articles | date = 24 October 2013 }}</ref>

When looking at the entire process of breast reconstruction, patients typically report that NAC reconstruction is the least satisfying step.<ref name=":2" />  Compared to a normal nipple, the reconstructed nipple often has less projection (how far the nipple extends beyond the breast mound) and lacks sensation.<ref name=":2" />  In women who have undergone a single mastectomy with reconstruction, another challenge is aesthetically matching the reconstructed NAC to the native breast.<ref name=":2" />