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During a mastectomy the whole breast is removed, usually including the nipple, 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:
It won’t be possible to keep the nipple if there is any possibility that the nipple or the surrounding tissue contains cancer cells.
If possible, a nipple reconstruction will be done at the same time as the breast reconstruction. However, if it can’t be done then, a nipple can be reconstructed at a later date. This is usually some time after the breast reconstruction has healed and settled into its final shape and position. This enables the surgeon to position the nipple accurately, in line with the one on your other breast. The time between the two operations for breast and nipple reconstruction may vary, but is usually about 4–6 months.
Two main techniques are used to reconstruct a nipple. In the first technique, skin on the new breast can be folded into a nipple shape – this is a nipple flap. In the second technique part of the nipple on the natural breast is removed and placed on the new breast – a nipple sharing graft. Both procedures are usually done under a local anaesthetic and you should be able to go home the same day.
It’s important to be realistic about what to expect from a reconstructed nipple. It will not react in the same way to temperature changes or touch - or have the same sensation as a natural nipple.
Tattooing after breast reconstruction can give the reconstructed nipple a very good appearance. It is usually done under local anaesthetic, using either a local anaesthetic cream or an injection. The procedure usually takes 30–40 minutes.
A semi-permanent pigment is injected under sterile conditions to prevent infection. The aim is to match the colour of the nipple and areola of your natural breast. The amount injected will vary slightly from person to person to give the best appearance. Sometimes the tattooing procedure needs to be repeated to give the best result. A couple of coatings usually lasts approximately 18 months to two years. The opposite nipple may need to be tattooed to get a good match.
The tattooing itself is not usually painful but the area may feel sore (like a graze) for a few days afterwards. You will probably be advised to wear a dressing over the area for about a week. This may need to be changed in case the dye leaks through the dressing.
You may decide that you don’t want to have another operation to make a nipple. In this case you could have a silicone stick-on nipple, which can be attached to the reconstructed breast. These can be bought ready-made, or made to match your other nipple. The nipple prostheses are usually made in the moulding room at the hospital.
Nipple prostheses (Photo supplied by Mr Mike Dixon)
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