Reconstructing the nipple after breast reconstruction - after risk-reducing mastectomy

Preserving the nipple Back to top

There are two options for keeping your own nipples:

• The nipple can be left attached to the skin of the breast with just the tissues underneath the skin 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 it may contain cancer cells; you can discuss this with your surgeon who can advise you what your options are.

Nipple reconstructing Back to top

If it isn’t possible to keep your own nipples it is usually possible to have them reconstructed. This can be done at the same time as the breast reconstruction or some time (perhaps a few months) after the breast has healed and settled into its final shape and position.

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.

Techniques used

Two main techniques are used to reconstruct a nipple:

Local skin flap surgery Using a local skin flap creates a nipple shape on the breast. Six to eight weeks later, the nipple and areola (the coloured area of skin around the nipple) are tattooed to give the right colour.

Skin graft More rarely, the nipple and areola are reconstructed from grafted skin tissue taken from areas of your body where the skin tends to be a darker colour, such as the top of the inner thigh or behind the earlobe.

Silicone stick-on nipples (nipple prostheses)

You may decide that you don’t want to have another operation to create a nipple. In this case you could have a silicone stick-on nipple, which can be attached to the reconstructed breasts. These can be ready-made, or custom-made to match your original nipples and areolas. The nipple prostheses are usually made in the hospital moulding room.

Silicone nipples can stay in position for up to three months after using a medical adhesive. The life of a nipple is approximately 18 months, but the moulds can be stored for years allowing new ones to be made as necessary.

Nipple tattooing

Tattooing after breast reconstruction can give the reconstructed nipple a very good appearance. If the nipple hasn’t been reconstructed, tattooing can be used to get the effect of a nipple and areola on the breast; this technique will not give the three-dimensional shape of a nipple but it can give a very good appearance.

Nipple tattooing is usually done under local anaesthetic, either using 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 exact colour will depend on your skin colour. And the amount injected will vary slightly from person to person to give the best appearance. Usually the tattooing procedure needs to be repeated to give the best result. The tattooing will usually last for about 18 months to two years.

The tattooing itself is not usually painful but the area may feel sore (like a graze) for a few days afterwards. You’ll probably be advised to wear a dressing over the area afterwards for about a week. This may need to be changed in case the dye leaks through the dressing.