Nipple Reconstruction After Breast Cancer

Primary (first time) nipple reconstruction. Actual patient of Dr. Devgan.

Primary (first time) nipple reconstruction. Actual patient of Dr. Devgan.

Secondary (second time) nipple reconstruction, 10 years after the initial reconstruction. Actual patient of Dr. Devgan.

Secondary (second time) nipple reconstruction, 10 years after the initial reconstruction. Actual patient of Dr. Devgan.

Breast reconstruction after breast cancer can be a long, multi-stage journey. However, technology for breast reconstruction has improved dramatically in the past decade, and results are better and more beautiful than ever. 

The initial stages of breast reconstruction involve creating a breast mound (the soft round form on the chest that mimics the female breast). This can either be done with a breast implant or with your own tissue (usually fat from the belly).

The final stage of breast reconstruction is often the reconstruction of the nipple (or nipple areolar complex). This procedure is more minor and can be done while you are awake, using only local anesthesia. However, it is a very gratifying operation, as the breast looks much more realistic when a nipple has been created. A reconstructed nipple is generally very durable. However, some women note that their reconstructed nipple tends to sink down and become more flat after several years have passed. In these women, we perform a secondary or revision nipple reconstruction.

Once the nipple has been made, most women choose to undergo areolar tattooing by a qualified tattoo artist. This is a final finishing touch that gives the reconstructed breast a beautiful, natural appearance.

For more information about breast or nipple reconstruction after breast cancer, please set up a consultation appointment with Dr. Devgan by calling (212) 452-2400.

Pediatric Plastic Surgery

Actual patient of Dr. Devgan, before and after repair of facial laceration.

Actual patient of Dr. Devgan, before and after repair of facial laceration.

As the mother of three young children, taking care of kids who require plastic and reconstructive surgery is a great joy of my job. Not only do I appreciate the gentle and delicate way kids relate to adults (especially scary doctors), but I also understand the things that can help keep them at ease. 

Singing Wheels on the Bus, watching Peppa Pig, giving out stickers and band-aids, sharing (sugar free) candies, and playing doctor to stuffed animals-- these are all part of my routine when helping kids through their tough times.

Whether your little one has a facial laceration from a fall on the playground, a hand injury from a mishap at home, a congential anomaly, a suspicious mole, or anything else, please do not hesitate to reach out to me if I may be of help. I take care of pediatric patients ranging in age from birth through the teenage years and beyond. I address concerns such as teenage breast reduction, teenage rhinoplasty (or nose job surgery), teenage torn earlobes from ear piercings, dog bites, cat scratches, and conditions that your child may have been born with such as cleft lip and palate. 

You may call my office 24-7 at (212) 452-2400 for either routine or emergency concerns, and you may always reach out to me via email at info@LaraDevganMD.com.

Actual patient of Dr. Devgan, before and after facial laceration repair.

Actual patient of Dr. Devgan, before and after facial laceration repair.

Actual patient of Dr. Devgan, before and after cleft lip repair.

Actual patient of Dr. Devgan, before and after cleft lip repair.

Actual patient of Dr. Devgan, before and after repair of torn earlobe.

Actual patient of Dr. Devgan, before and after repair of torn earlobe.

Actual patient of Dr. Devgan, before and after repair of nasal dog bite injury/ facial laceration.

Actual patient of Dr. Devgan, before and after repair of nasal dog bite injury/ facial laceration.

Inverted Nipple Correction

Actual patient of Dr. Devgan, before and after correction of inverted nipple.

Actual patient of Dr. Devgan, before and after correction of inverted nipple.

Inverted nipples occur frequently and are often a source of discomfort or self-consciousness for women who have them.

What is an inverted nipple?

When a woman has an inverted nipple, her nipple points inward and is recessed below the level of her breast. This can make the nipple appear flat, or in severe cases, it can make what is ordinarily the most prominent part of a nipple appear to be a recessed hole in the center of the breast.

Can nipples sometimes be inverted and sometimes be normal?

In some women with inverted nipples, touch, stimulation, or temperature changes can make the nipple "pop out" or reappear. In other women with inverted nipples, the nipples are so thoroughly tethered downward that they are "stuck" in a recessed position.

Do inverted nipples affect body image, sex, and breastfeeding?

In addition to the discomfort about the way that inverted nipples look, women with inverted nipples are also typically not able to breastfeed, and they report decreased sensation and sexual satisfaction with regard to their breasts.

How are inverted nipples corrected?

If you have an inverted nipple, Dr. Devgan can correct it with a short procedure done under local anesthesia only. By making a tiny incision at the base of the nipple (and hidden within the areola), Dr. Devgan will surgically draw the nipple outward and support it in a normal, popped-out position using carefully placed sutures. You are able to return to work later that same day or the next day, and downtime is minimal. Healing is generally complete within 2-4 weeks.

For more information:

If you are interested in correction of inverted nipples in New York City, please call (212) 452-2400 to make a consultation appointment with Dr. Devgan. You may also email info@LaraDevganMD.com if you have specific questions.

Talk Like a Doctor: Is There Gender Bias when Physicians Speak?

female plastic surgeon NYC

This personal essay was an invited article for The Doctor Blog by ZocDoc.

July 31, 2015
By Lara Devgan, MD

I have given a number of medical talks over the years-– reports on my research, reviews of surgical topics, mentoring speeches, and grand rounds, among others. I prepare for these talks extensively but tend to speak extemporaneously to engage better with my audience. I’m pleased to say that, in general, I have received good feedback. Several times, however, I have been given the “constructive criticism” that my voice is “girly” or “immature.”

I will be the first to admit that I am not an expert on oration or public speaking. I have no background in stage acting or performance. And despite the speech accolades of my youth (as a high schooler I was the Lincoln-Douglas Debate state champion in California, and while in college a friend and I won the Adams Cup for Parliamentary Debate at Yale), I know very little about what the ideal speaking voice is supposed to sound like.

My focus for my medical talks is simple and content-based: speak clearly, convey my message, and use a voice that my audience will understand. To be sure: I am a woman of petite stature, and my speaking pitch is soprano to mezzo-soprano. I am also a fully grown adult with gray hair and a busy plastic surgery practice, who has published and spoken extensively in my field.

Yet with recent media attention to the many perceived flaws with female voices, I cannot help but wonder about the extent to which this phenomenon applies to the world of science and medicine.

Women have been criticized for “upspeak”-– using a voice that trails upward in pitch at the end of a sentence. This is a version of a “Valley Girl” lilt, and it has been described by linguist Mark Liberman as a speech pattern that makes it sound like we are asking for permission or posing a question. It sounds weak and lacks authority, we are told. Kelly Ripa is an example of a woman who frequently employs upspeak.

Conversely, women are also criticized for “vocal fry”-– using a hoarse, low-pitched rumble that is commonly employed to add emphasis, depth, or satire to speech. According to NPR On the Media host Bob Garfield, this sounds unrefined and lacks gravitas; he says it is “annoying,” “repulsive,” and “mindless.” Examples of vocal fry users include Tina Fey and Lindsay Lohan.

Interestingly, vocal fry has been described as “the opposite of upspeak” by The Daily Dot’s Amanda Marcotte. She argues that it conveys more authority than monotone speech because the voice takes on a lower pitch at the end of a sentence. Yet it is still derided as an irritating female speech affectation.

There is also a more general series of complaints about women’s voices that reverberates in the media. Hillary Clinton’s voice is too “nagging” according to Fox News journalist Mark Rudov, Sarah Palin’s voice “causes ears to bleed” according to the Free Wood Post, and Ann Coulter’s “whiny voice is so distracting” according to AOL TV reporter Jane Boursaw. Politics aside, these complaints cross the aisle to suggest that there are very few pleasing and acceptable ways women can speak.

Taken as a whole, criticisms of female voices of authority are difficult to make sense of. If women’s voices are derided for being high-pitched, low-pitched, varied, and, well, feminine, how exactly are women in professional roles supposed to speak?

In medicine, public remarks are intended to educate and elucidate content-heavy material. Perhaps even more so than in other realms, the topics we discuss publicly are technical and complex: molecular biology, anatomy, pharmacology, physiology, pathology, and more. While speaking voices should certainly be clear, the societal trend of policing women’s voices distracts and detracts from this important subject matter.

There is no way to take the woman out of her own voice, nor should there be. Women have smaller vocal folds and laryngeal cavities than do men, generally speaking, and it is unsurprising that the higher pitch and lower volume of female speech patterns reflects this. Also unsurprising is the female tendency to use forms of vocal inflection to vary oratory sounds, given that there is less possible volume variation.

This variance in women’s speech does not make it girly, immature, whiny, cloying, annoying, or otherwise objectionable. It simply makes it the way half of the population tends to vocally project. And in medicine, as in all fields, it makes it worth listening to.

Click to read this article on The Doctor Blog by ZocDoc.

Click to read this article on The Doctor Blog by ZocDoc.