If the nipple and areola are removed during mastectomy, they can be recreated. For some women this option is important as it marks the completion of their reconstruction journey, while others are happy with the look of their new breast without a nipple. For those women who do not want further surgery they may wish to consider getting a tattoo, or may opt for using nipple prostheses.
In any case, the choice is up to you, and as nipple reconstruction is done at least 3 or 4 months after reconstruction surgery – in order to allow the reconstructed breast time to heal and settle into place - you have time to decide whether you would like to pursue this option.
In any case, the choice is up to you, and as nipple reconstruction is done at least 3 or 4 months after reconstruction surgery – in order to allow the reconstructed breast time to heal and settle into place - you have time to decide whether you would like to pursue this option.
What are my options?
Nipple Reconstruction Surgery: The nipple may be reconstructed from the surrounding skin at the site desired for nipple placement. The surgeon makes small incisions to create a flap on the reconstructed breast and then elevates the tissue into position, forming and shaping it into a living tissue projection that mimics the look of the natural nipple. The reconstructed nipple will not feel and behave as it did before your mastectomy. Nipple sensation will not be the same and there may not be any feeling in the nipple at all. Reconstructed nipples will not become erect when touched or change size with changes in temperature.
The other surgical option is to take a small skin graft from the end of a reconstruction scar (usually from the abdomen or back) to create a raised nipple. In the past, some surgeons have also created a new nipple by sharing a piece of the nipple from the opposite breast. However, this technique is not as popular today as it carries a risk that the transferred nipple tissue to the reconstructed breast could potentially form a new breast cancer. |
An example of how a nipple can be created using skin and tissue from the reconstructed breast. |
Once the nipple is created, it can be tattooed to give the appearance of an areola and match the colour of the other breast’s areola. As the new breast has little or no sensation, the tattooing is usually painless.
Most reconstructive surgeons can do the tattooing or have a trained nurse do it, but you may prefer to have the nipples tattooed by a professional medical tattooist or specially trained cosmetic therapist. The methods generally used include; dermabrasion or micro-pigmentation. To achieve the colour required, several sessions may be needed, and initially, the tattoo will look darker than the remaining nipple, but it will fade with time. |
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All nipple reconstructions lose some projection as part of the normal healing process. However, if the nipple flattens more than expected, your surgeon may have to redo the reconstruction and reinforce the nipple with a graft of scar tissue, fat, or dermal matrix material.
Nipple Tattoos: Instead of surgery, some women choose to have a nipple tattooed onto the reconstructed breast. Using colour, shading, and highlighting skills to produce a result with both visual and physical depth, a trained medical or cosmetic tattooist can create the appearance of an actual nipple.
The most realistic results are often achieved with 3D nipple tattoos, which are basically real tattoos that use oscillating needles coated with pigment. The needles insert the pigment into the skin. This approach essentially creates a “picture” of a nipple and has no physical dimension, but it can look quite real. A tattoo artist can use a wide range of colours and one session is usually all that’s needed, although it may require touchup sessions over time. 3D tattoos are permanent and usually don’t fade. 3D nipple tattooing can be used to create new nipples and to colour-correct previous nipple tattoos that have faded or have undesirable colours. This option is not widely available in Australia but there may be opportunity in the future for women to access this type of tattooing.
Decorative Tattoos: Instead of a nipple tattoo, a growing number of women have decided to cover their reconstruction and mastectomy scars with more decorative tattoos. Meaningful images can be a way of both recognising and providing expression of the individual’s personal journey through breast cancer.
Nipple Prosthesis: Some women prefer to use stick-on (adhesive) nipples. Using special glue, these adhesive nipples stick to the skin and will stay in place for several days. Stick-on nipples are available from breast prostheses suppliers.
The most realistic results are often achieved with 3D nipple tattoos, which are basically real tattoos that use oscillating needles coated with pigment. The needles insert the pigment into the skin. This approach essentially creates a “picture” of a nipple and has no physical dimension, but it can look quite real. A tattoo artist can use a wide range of colours and one session is usually all that’s needed, although it may require touchup sessions over time. 3D tattoos are permanent and usually don’t fade. 3D nipple tattooing can be used to create new nipples and to colour-correct previous nipple tattoos that have faded or have undesirable colours. This option is not widely available in Australia but there may be opportunity in the future for women to access this type of tattooing.
Decorative Tattoos: Instead of a nipple tattoo, a growing number of women have decided to cover their reconstruction and mastectomy scars with more decorative tattoos. Meaningful images can be a way of both recognising and providing expression of the individual’s personal journey through breast cancer.
Nipple Prosthesis: Some women prefer to use stick-on (adhesive) nipples. Using special glue, these adhesive nipples stick to the skin and will stay in place for several days. Stick-on nipples are available from breast prostheses suppliers.
Pink Perfect Prosthetic Nipples
The nipples are handmade from platinum grade silicone which has a similar look & feel of a real skin and their thin edges provide a perfect match with your breasts! The nipples are attached to the breast by using a medical adhesive which is waterproof and strong enough for any day-to-day activity! |
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What to expect with nipple reconstruction surgery:
Before nipple reconstruction surgery: Nipple reconstruction is usually carried out several months after breast reconstruction in order to allow the breast time to heal and to drop and settle into place, giving the surgeon a better idea of where to place the new nipple.
Nipple reconstruction surgery is usually done as day surgery and is considered part of the reconstructive process, and is therefore not cosmetic surgery. Your doctor will give you a list of instructions on how to prepare for nipple reconstruction surgery. You'll probably be told not to eat or drink anything and there will be medications that you shouldn't take before the surgery. You also will need to make arrangements for someone to drive you home. Prior to going into theatre, your surgeon will draw markings on your breast (and donor site if skin from another area of your body is being used) to show where the incisions will be made. Usually this is done with a felt-tip marker. You’ll probably be standing up while this happens. Nipple reconstruction may be done under local anaesthetic, particularly if this is the only procedure you are having at that time. This means that your doctor will use a needle to inject numbing medication into the area where the reconstructed nipple will be. If you have local anesthetic, you will be awake during the procedure. If you and your doctor decide that nipple reconstruction surgery should be done under general anaesthesia (especially if any other procedure is being carried out at that time e.g. breast lift on the remaining breast), an intravenous infusion (IV) line will be inserted into your hand or arm and taped into place. You'll be given relaxing medication through the IV line. Skin to create the new nipple is usually taken from the site where the new nipple will be located. This has become the favored approach. However, some surgeons still do take skin from the inner thigh or labia (skin folds around the vagina) and graft it onto the breast to form a nipple. Another potential source is the opposite breast. Make sure you’re clear about how the reconstruction is being done and why, especially if a graft is recommended. If your doctor is taking skin from another place on your body to reconstruct the nipple, that area will be numbed with local anesthetic as well. Only a small amount of skin is needed to recreate the nipple. |
During nipple reconstruction surgery: Typically, a small incision is made at the site where the nipple will be made. The skin is formed into a nipple shape and small sutures (stitches) are used to secure the form. The new nipple and surrounding areola can be tattooed about 3 months after surgery.
If your surgeon plans to use grafted skin as part of the nipple reconstruction, there will be an incision in the area from which the skin was taken. Again, be sure to clarify whether this will be necessary or not, and if so, why. Grafted nipple reconstructions can sometimes have a “stamped on” appearance where the edge of the reconstructed areola meets the surrounding breast skin. Some surgeons insert a core of dermal matrix product – a skin substitute such as AlloDerm - into the reconstructed nipple so it doesn't flatten out too much. However, most surgeons will use a small amount of your own scar tissue or fat to accomplish the same goal. Once the nipple is sewn into place, a nipple shield or other protective covering is taped over the new nipple to protect it. After nipple reconstruction surgery: If you've had local anesthesia, you'll be able to go home after the nipple shield is in place. If you've had general anesthesia, you'll be moved to a recovery room after surgery, where hospital staff members will monitor you. Once you're awake and your doctor has checked your heart rate, body temperature, and blood pressure, you'll be allowed to go home. No matter which type of anesthesia you have, make sure you arrange for someone else to drive you home. Your doctor will give you specific instructions to follow for your recovery. The nipple shield is usually left on for about 3-5 days. After it's removed you can shower. Your reconstructed nipple will probably look pointed and somewhat larger than your other nipple. After the stitches are removed -- usually after 2 weeks -- the nipple will begin to flatten out and look more like your other nipple. The reconstructed nipple can be tender for a week or so. Ask your doctor for medicines you can take to ease any pain you may have. |
How long is this operation? Nipple reconstruction surgery normally takes 30 minutes – 1 hour. Tattooing, which happens about 3 months after the nipple reconstruction surgery, usually takes 30 to 40 minutes, although several sessions may be needed to achieve the right colour.
What is the estimated hospital stay? Day surgery.
What are the risks?
Like all surgery, nipple reconstruction surgery has some risks, including;
Tissue breakdown: In very rare instances, the tissue used to reconstruct the nipple won't get enough blood and some of the tissue might die. If this happens, your surgeon will have to trim away the dead tissue and reconstruct the nipple again. This is done in an operating room under general anesthesia.
Nipple flattening: In rare instances, the reconstructed nipple may flatten out more than expected. If this happens, your surgeon may have to redo the nipple reconstruction and reinforce it with a graft of scar tissue, fat, or dermal matrix material to reduce the risk of flattening.
Tissue breakdown: In very rare instances, the tissue used to reconstruct the nipple won't get enough blood and some of the tissue might die. If this happens, your surgeon will have to trim away the dead tissue and reconstruct the nipple again. This is done in an operating room under general anesthesia.
Nipple flattening: In rare instances, the reconstructed nipple may flatten out more than expected. If this happens, your surgeon may have to redo the nipple reconstruction and reinforce it with a graft of scar tissue, fat, or dermal matrix material to reduce the risk of flattening.
Post op advice
While nipple surgery is technically much easier than any other part of the reconstruction process, much of the success of the surgery will rely on good post-operative care:
- Your plastic surgeon will give you post-operative instructions before you leave the hospital, make sure you follow them to ensure the success of your surgery.
- Each surgeon has preferred methods for protecting the new nipple. After surgery, you will go home wearing a surgical or sports bra which will securely hold the protective covering / shield in place. Most surgeons prefer that you keep the garment on until your next office visit, usually within five to seven days (unfortunately, that may mean no showers). At that time the dressing will be taken off, and after you are cleaned up, you will get your first look at your new addition(s).
- Do not remove, play with, or even sneak a peek at the dressing that your surgeon has put on you after surgery.
- When your surgeon takes the bandage off, don’t be alarmed if there is discoloration, if the nipple is swollen, or if there are scabs or stitches sticking out, this is all normal and the nipple will heal in time. Moisturising the nipple will help it to heal faster.
- The first two to three weeks are critical. Even after the surgeon has removed the initial bandage, you don't want to compress the nipple. Nipple compression can be minimised by using gauze pads and some paper tape, or placing gauze inside a soft, cotton bra (such as an Aah Bra).
- When showering, do not scrub the nipple. Do not use harsh soap or body wash on the nipple, and avoid scented lotions. Gently wipe around the nipple to keep it clean and dry it well after showering.
- No swimming or baths for 4 weeks.
- If you engage in sexual activity, avoid the nipple area until everything has fully healed.
- If your breast was radiated, you should have a reasonable expectation for the nipple. Sometimes it is harder to achieve a lot of volume, and projection, depending on the skin on the breast mound.
- At about 6 weeks the nipple is usually at the desired size. It will flatten. This is a fact. But, many women will tell you, that even if the nipple flattens over time, it still makes the breast look very real. There are a lot of options to give lasting projection to a flattened nipple, such as; dermal filler injections, fat grafts or dermal matrix materials such as AlloDerm and Strattice.
- Nipples take a long time to totally heal and look normal. Tattoos can further enhance the look of the nipple and areola and may be done from at least 3 months after nipple reconstruction surgery.
Reviewed by:
Dr Pouria Moradi
MBBS BSc (Med)
MRCS (Eng) FRACS (plas)
Reference sources:
Breastcancer.org:
http://www.breastcancer.org/treatment/surgery/reconstruction/types/nipple
Australian Society of Plastic Surgeons:
http://www.plasticsurgeryfoundation.org.au/patient-information/procedures
Cancer Australia:
http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/breast-reconstruction/types/breast-refinement-procedures
Cancer Council:
http://www.cancercouncil.com.au/88008/b1000/breast-prostheses-reconstruction-52/nipple-reconstruction-and-the-remaining-breast
Breast Cancer Network Australia (BCNA):
https://www.bcna.org.au/understanding-breast-cancer/treatment/breast-reconstruction/
BreastReconstruction.org:
http://www.breastreconstruction.org/SecondaryProcedures/NippleAreolaReconstruction
Cancer Research UK:
http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/treatment/surgery/reconstruction/types-of-breast-reconstruction
Breast Reconstruction Online Group:
http://202.129.142.90/online-network/groups/breast-reconstruction-online-group/blog/protecting-nipples-after-nipple-reconstruction#sthash.a92hl85D.dpuf
Dr Pouria Moradi
MBBS BSc (Med)
MRCS (Eng) FRACS (plas)
Reference sources:
Breastcancer.org:
http://www.breastcancer.org/treatment/surgery/reconstruction/types/nipple
Australian Society of Plastic Surgeons:
http://www.plasticsurgeryfoundation.org.au/patient-information/procedures
Cancer Australia:
http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/breast-reconstruction/types/breast-refinement-procedures
Cancer Council:
http://www.cancercouncil.com.au/88008/b1000/breast-prostheses-reconstruction-52/nipple-reconstruction-and-the-remaining-breast
Breast Cancer Network Australia (BCNA):
https://www.bcna.org.au/understanding-breast-cancer/treatment/breast-reconstruction/
BreastReconstruction.org:
http://www.breastreconstruction.org/SecondaryProcedures/NippleAreolaReconstruction
Cancer Research UK:
http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/treatment/surgery/reconstruction/types-of-breast-reconstruction
Breast Reconstruction Online Group:
http://202.129.142.90/online-network/groups/breast-reconstruction-online-group/blog/protecting-nipples-after-nipple-reconstruction#sthash.a92hl85D.dpuf