For this patient, we recreated an areola over a scar across a newly-inserted implant. The areola and nipple, along with breast tissue, were all removed during the patient’s mastectomy surgery and an implant was inserted by the surgeon to rebuild the breast. If patients have been referred to me from a surgeon, we ensure communication with the surgeon and work to the time frames they suggest so that the area heals well. We recreated the areola and nipple by using three different shades.
By using a circular movement, with a five-round needle, we were able to create a ripple effect, resulting in a more textured appearance, which produced a very natural-looking areola. For the nipple, we then used some lighter shades to create a ring with a three-micro needle device, giving the illusion of an outward-projecting nipple. A eleven- flat needle was then used on the outer edge of the areola. This provided a softened edge, to ensure the areola did not look ‘too perfectly’ circular. All of these needles mentioned vary in thickness and are commonly used for shading work and to create a circle formation on the skin.
This type of procedure can take two sessions or more. If the scar tissue is dense and tight, then care is needed when inserting the needle, so that the placement of the pigment goes into skin, to achieve the desired results. If too much pressure is used, the pigment could merge out and the resulting color may appear too grey. If not enough pressure is used, then during the healing process, the pigment may be rejected and leave the skin. In my experience, a scar which is silvery white and flat, with not much tight scar tissue, would retain the most pigment and the best- looking result, however it is important to note that no scar is consistent all the way through.
After the first session, the patient was very pleased, but during healing there was some unevenness in pigment, which is completely normal. In the second session, I went over the area again and evened out the pigment. The first procedure would have broken down some of the scar tissue present in the areola and, from personal experience; it’s almost always easier to get pigment to sit correctly the second time around. The procedure usually takes around two hours. There can be some soreness or swelling to the area, which sometimes lasts up to five days. A light dressing should be applied following the procedure. I normally advise my patients to wear loose, comfortable clothing and most definitely a loose-fitting bra; they normally have their post-surgical bra. The way pigment breaks down in each patient is different but generally, most patients will not need the area retouched for about five years. Overall the patient was happy. In my experience of treating breast cancer patients, this is their chance to fully say goodbye to cancer and frequently provides patients with a sense of closure.