13.  What are the common methods of nipple/areolar reconstruction?  How is tattooing done?

Answer:
Areola reconstruction:
 Upper inner thigh graft.
 Retroauricular graft.
 Nonspecific tissue grafting with tattoo: usually from lateral portion of mastectomy scar.
 Tattoo alone.

Nipple reconstruction:
 Opposite nipple: only used when donor nipple needs to be reduced. Can use distal portion or one side of nipple.
 Skate flap: an areolar circle is drawn and the upper one-third is de-epithelialized. Underlying subcutaneous tissue is lifted up to create the base.
 Mushroom flap: concentric circles are marked on the areola and V-shaped pieces of skin are excised on the periphery and the center circle is elevated to become the nipple.

Tattooing: After selection and mixture of pigments, needle of the tattoo gun is dipped in the pigment and applied in a radial and circular pattern until the areolar circle is uniformly filled in.  A slightly darker pigment is then used for the nipple
 

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