Reconstructing the nipple after breast reconstruction
As part of a mastectomy, the nipple is usually removed, but it can be reconstructed.
However it may be possible to keep your nipple if you are having all the breast tissue removed with immediate reconstruction. There are two options for keeping your own nipple:
The nipple can be left attached to the skin of the breast and only the tissues under the skin are removed.
The nipple and its surrounding skin may be removed with the rest of the breast tissue and then attached (grafted) onto the reconstructed breast.
It won’t be possible to keep the nipple if there is any possibility that the nipple or the surrounding tissue contain cancer cells.
Occasionally nipple reconstruction is done at the same time as breast reconstruction, but it is usually done some time afterwards. This lets the breast settle into its final shape so that the surgeon can position the nipple accurately, in line with your other nipple. The time between operations for breast and nipple reconstruction may vary, but it’s usually about 4-6 months.
Your nipple shape may be reconstructed using a:
nipple flap - the surgeon folds skin on your new breast into a nipple shape
nipple sharing graft - the surgeon takes part of the nipple from your natural breast and places it on your new breast.
These procedures can be done under a local or a general anaesthetic. It’s usually possible to go home on the same day.
A reconstructed nipple doesn’t react to temperature changes or touch - or have the same sensation as a natural nipple.
Nipple/areola tattooing (micro-pigmentation)
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Once you have a new nipple shape, you can have the new nipple and area around it tattooed to match the colour of the nipple and areola (darker area around the nipple) of your natural breast. This is done in the hospital. You’ll be given a local anaesthetic cream or injection to numb the nipple and surrounding skin.
A tattooing session usually takes 30-40 minutes. The procedure may need to be done more than once to give the best result. The tattoo usually lasts approximately 18 months to two years. Sometimes the opposite nipple is also tattooed to ensure a good match.
Tattooing isn’t usually painful but the area may feel tender (like a graze) for a few days afterwards.
If you decide you don’t want to have another operation to make a nipple, you may prefer to have a silicone nipple, which you can attach to your reconstructed breast. Once the nipple is fixed to the breast with a special adhesive, it can stay in place for up to three months. Ready-made nipple prostheses come in various shades and sizes so most women find a good match with their other nipple. Nipple prostheses can also be custom-made to match your other nipple.