Reconstructing the nipple after breast reconstruction
As part of a mastectomy, the nipple is usually removed. However, it may be possible to keep your nipple.
This is usually possible if the risk of the nipple or surrounding tissue containing cancer cells is very low, your breast shape is suitable and if you are having an 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 breast tissue that lies under the skin is removed.
The nipple and the surrounding darker skin (areola) may be removed with the rest of the breast tissue and then attached (grafted) on to the reconstructed breast.
Sometimes the preserved nipple needs to be removed in the weeks following the breast reconstruction operation. This may happen if there are cancer cells found in the tissue removed near the nipple. It may also be done if the blood supply to the preserved nipple is not good enough and the nipple dies.
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 is usually about 4–6 months.
Your nipple shape may be reconstructed using a:
nipple flap – the surgeon folds skin on to 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 is usually possible to go home on the same day.
A reconstructed nipple does not react to temperature changes or touch and does not 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 of your natural breast. This is done in the hospital. You may have some local anaesthetic cream put on the nipple and surrounding skin to numb the area before any tattooing is done.
A tattooing session usually takes 30–40 minutes. It may need to be done more than once to give the best result. It usually lasts about 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 one, which you can attach to your reconstructed breast. Once the nipple is fixed to the breast with special adhesive, it can stay in place for up to three months.
I have a set of stick-on ones, which look fantastic as they are modelled on the remaining one.
Ready-made nipple prostheses come in various shades and sizes, so most women find a good match with their other nipple. They can also be custom-made to match your other nipple.