This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions. Q:  Can you tell me how successful you have been in doing nipple reconstruction and what technique you use? I had one done from tissue gathered from my own breast, then had fat transferred but it is still flat. Now that I am losing the other breast (2nd mastectomy) I would like to have a protruded nipple even if just a bit on each breast. A:I use the "skate flap" technique, although many similar techniques using local tissue exist. There are, in my experience, two potential problems which may cause nipple reconstruction to be unsuccessful.1) Sometimes, a portion of the flap just dies. This is, to a large extent, unpreventable and unpredictable, as these flaps are too tiny to be based on any known blood vessel. Additionally, the need to put the nipple in the proper location precludes altering its design to potentially improve blood flow.2) We have learned that it is essential to protect the flap from the pressure of clothing until it is fully healed (at least one month). There are special domed "Tupperware" protectors made just for this purpose.It helps to make the nipple larger than desired at first. That leaves a little leeway if things go awry, and it only takes a few minutes to reduce a nipple in the office if it ends up being too large.Hope this helps, good luck.Q: I have just been diagnosed with breast cancer of the right breast. The surgeon suggest bilateral mastectomy due to family history. Should I meet with a plastic surgeon before the surgery or get a 2nd opinion?A: Whether or not you ultimately decide to have reconstruction (at the time of mastectomy, or later), you should at least speak with a plastic surgeon beforehand so that you know all of your potential options. Ideally, your breast surgeon already works with one or more plastic surgeons, and can help direct you to one.Dr. Richard Kline Center for Natural Breast Reconstruction

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