Nipple reconstruction

As part of a mastectomy, the nipple is often removed. But there are ways to keep or replace it. Sometimes the nipple can be left attached to the skin of the breast, or removed and then grafted onto the reconstructed breast.

Nipple reconstruction is usually done 4-6 months after breast reconstruction or, occasionally, at the same time. 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 – part of the nipple from your natural breast is placed on your new breast.

Once you have a new nipple shape, you can have the new nipple and area around it tattooed to give a more natural colour. This is done in the hospital.

If you don’t want to have nipple reconstruction, you may prefer to have a silicone nipple. The nipple is fixed to the reconstructed breast with a special adhesive and can stay in place for up to three months.

The nipple

As part of a mastectomy, the nipple is often removed. However, it may be possible to keep it. Your surgeon will discuss this with you before the operation. Keeping the nipple and areola can sometimes mean that a small amount of breast tissue is left behind. Your surgeon can explain the risks and benefits of keeping the nipple and areola. They may be preserved when the risk of the nipple or surrounding tissue containing cancer cells is very low, your breast shape is suitable and 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 which lies under the skin removed.
  • The nipple and the surrounding darker skin (areola) may be removed with the rest of the breast tissue and then attached (grafted) onto 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.


Nipple reconstruction

Occasionally nipple reconstruction is done at the same time as breast reconstruction, but it is usually done some time afterwards. This lets the shape of the breast(s) settle so that the surgeon can position the nipple accurately. 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 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. This isn’t an option for women who have had both breasts removed.

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)

Once you have a new nipple shape, you can have the new nipple and area around it tattooed. This will match the colour of the nipple and areola (darker area around the nipple) of your natural breast. Or, if you have had both breasts reconstructed the tattoo will be matched to your skin tone to give a natural looking result.

Tattooing is done in the hospital. You may have some local anaesthetic cream put on the nipple and surrounding skin to numb the area before it is done.

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 is not usually painful but the area may feel tender (like a graze) for a few days afterwards.


Nipple prostheses

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. Nipple prostheses can also be custom-made.


Back to Types of breast reconstruction

Surgery to the other breast

Some women have an operation on their natural breast so that the reconstructed and natural breasts look as similar as possible.