A nurse receives training in breast areola tattooing (©Sankei/Ayako Tsugawa).
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A mastectomy can mean the loss of a breast, and that sense of loss varies from person to person. Knowing the full range of reconstruction options can help patients make an informed choice about treatment before they ever need to.
Roughly one in nine women in Japan is expected to develop breast cancer at some point.
Covered by Insurance, Yet Largely Unknown
Patients who undergo a mastectomy can have reconstructive surgery under national health insurance. Even so, calculations based on the health ministry's 2024 fiscal year open claims data show that only around one in eight patients who underwent a full mastectomy went on to have reconstruction.
Tomoyuki Yano, head of the plastic surgery department at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, points to several reasons.
Yano points to a lack of awareness as the main barrier. Many patients don't realize reconstruction is covered by insurance, and the age group most affected by breast cancer often overlaps with child-rearing or peak working years, leaving little room to raise the subject after using up paid leave on treatment. "It also seems difficult for some to ask their attending physician about reconstruction, assuming that once it heals, the appearance will probably be fine," Yano says.
There are two main approaches to breast reconstruction: autologous reconstruction, which transplants fat from the abdomen, back, or thighs to the site of the mastectomy, and implant-based reconstruction, which replaces the breast with a gel-filled prosthesis in surgery.
In some cases, a device called a tissue expander is inserted at the breast site to stretch the skin before reconstruction; in others, reconstruction takes place at the same time as the mastectomy.
Same-Day Nipple and Areola Procedures
Most full mastectomies involve removal of the nipple and areola, and their reconstruction is usually handled separately from the breast itself. Options include insurance-covered surgery and elective, out-of-pocket medical tattooing.
There are two surgical approaches, both of which can be done under local anesthesia on an outpatient basis. The first transplants roughly half of the nipple and areola from the opposite side, matching shape and color, though as Yano notes, "there is a risk that the transplanted skin will not take properly and will become necrotic." Skin from the thigh is sometimes used for the areola instead.
The second method, known as flap reconstruction, involves incising the breast skin and suturing it into a three-dimensional shape to form the nipple alone. The result matches normal skin tone, so some patients follow up with medical tattooing to add color separately.
Medical Tattooing
Medical tattooing techniques have advanced in recent years. 3D areola tattooing, which creates a three-dimensional impression of the nipple and areola through tattooing, has begun to spread. Nurses trained in the technique perform the procedure under a doctor's instruction.
Yoshiko Iwamoto, a nurse and representative of Re. Breast Art Make School Terakoya, a group involved in promoting and teaching the technique, says some patients hesitate to undergo treatment because they're resistant to changes in the shape of their breast. "If they know there are various ways to restore the breast's appearance, they may be able to face treatment without hesitation," she says.
The outpatient procedure is elective and costs roughly ¥60,000 (about $400) per session, with most patients requiring two to three sessions in total.
When Iwamoto presented the technique at the Japanese Breast Cancer Society's annual academic meeting in Kyoto in June, she says a doctor approached her afterward, asking about drafting a protocol, including details on where the procedure could be performed.
A list of medical institutions offering the procedure is available on the Re. website.
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Author: The Sankei Shimbun
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