The nipple is usually removed as part of a mastectomy. But it may be possible to keep it when having an immediate reconstruction. This is called a nipple-sparing breast reconstruction.
Preserving the nipple is usually possible if:
- the risk of the nipple or surrounding tissue containing cancer cells is very low
- you have a suitable breast shape.
There are 2 ways a surgeon may do this:
- The nipples are left attached to the skin of the breasts and the breast tissue that lies under the skin is removed.
- The nipples are removed alone or along with the surrounding darker skin (areola). They are then reattached (grafted) onto the reconstructed breast.
If you are having risk-reducing surgery, another way involves first having an operation to reposition the nipples and reduce the breast skin. This is called a breast uplift or mastopexy. You then have a second operation to remove the breasts through the lower scar under the breasts and the breast reconstruction.
Sometimes the nipple needs to be removed in the weeks after breast reconstruction. This may happen if the blood supply to the nipple is not good enough and the nipple tissue dies.
It may also happen if there are cancer cells found in the tissue removed from near the nipple.
If you are having risk-reducing breast surgery, samples of the removed breast tissue are examined under a microscope. If there are cancer cells found in the tissue removed under the nipple, it may need to be removed.
If you are having risk-reducing breast surgery, it may be possible to have a nipple-sparing breast reconstruction with implants . But it can sometimes be difficult to achieve the best nipple position. The nipples may be too low. You may also have reduced sensation in the nipples, and they may feel numb. There can also be a slight increase in wound-healing problems if some breast skin needs to be removed during reconstructive surgery.
If the nipple position is too low, you can have further surgery to correct it. Or the surgeon may suggest having surgery to make sure the nipple is in the right position before risk reducing surgery and breast reconstruction instead.
The surgeon may suggest an operation to:
- raise the breast and reposition the nipple and areola
- reduce some of the breast skin (mastopexy).
These may be suggested if you have naturally larger breasts.
If your nipple is removed as part of your surgery, you will usually be offered nipple reconstruction.
This sometimes happens at the same time as breast reconstruction. But it is usually done as a different operation, a few months afterwards. This delay lets the reconstructed breast settle into its final shape so the surgeon can position the nipple accurately.
The time between operations for breast and nipple reconstruction may vary. It is usually about 4 to 6 months but may be longer.
You usually have nipple reconstruction done under a local anaesthetic. But you may have a general anaesthetic. You can go home the same day.
Your nipple shape may be reconstructed in 2 ways:
- Using a skin flap. The surgeon folds skin onto your reconstructed breast into a nipple shape. They make it bigger than normal. This is because the reconstructed nipple will shrink and usually flattens with time.
- Using a nipple-sharing graft. The surgeon takes part of the nipple from your natural breast and places it on your reconstructed breast.
Recovery after a nipple reconstruction
When you go home, you will have a dressing over the nipple area. This will be removed when you have a follow-up appointment. Your nursing team will advise you about this.
A reconstructed nipple does not react to temperature changes or touch. It does not have the same sensation as a natural nipple and is likely to be numb. It may also not be the same colour as a natural nipple.
The reconstructed nipple needs a good blood supply from the tissue of the reconstructed breast. If the blood supply is poor, the nipple reconstruction may not be successful.
If you have new nipples made, you can have them and the area around them tattooed to look a more natural colour. This is sometimes called micropigmentation.
This can be done to match the colour of the nipple and areola of your other breast. Sometimes the other nipple is also tattooed to ensure they match.
A reconstructed breast does not have the same sensation as a natural breast. Most people do not feel any discomfort when the tattooing is being done. If you have feeling in the nipple area, you can be given local anaesthetic cream to numb it.
A tattooing session usually takes 30 to 40 minutes. It may need to be done more than once to give the best result. The tattoo usually lasts about 18 months to 2 years.
Some hospitals offer three-dimensional (3D) tattooing. This can create the appearance of a nipple and areola without nipple reconstruction. The area is tattooed in different shades to create a 3D appearance.
Nipple tattooing is usually done in the hospital outpatient department.
If you do not want to have nipple reconstruction or tattooing, you may choose to have a silicone nipple (nipple prothesis). You can attach it to your reconstructed breast. You fix the nipple to your breast with special adhesive. It can stay in place for up to 3 months.
Ready-made nipple prostheses come in different shades and sizes. You can usually find a good match with your other nipple.
You can also get custom-made nipple prostheses to match your other nipple. This may involve having a mould made of the nipple on your other breast. Colours are then added to the nipple prostheses to match your other nipple as closely as possible. This procedure is only available in some hospitals.
Below is a sample of the sources used in our breast reconstruction information. If you would like more information about the sources we use, please contact us at email@example.com
European Journal of Surgical Oncology. Oncoplastic breast surgery: A guide to good practice A. Gilmour et al. Published 5th May 2021. associationofbreastsurgery.org.uk/media/359061/abs-oncoplastic-guidelines-2021.pdf (accessed April 2023)
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. Guidelines. July 2018. Last updated: April 2023. Available from: www.nice.org.uk/guidance/ng101 (accessed April 2023)
European Society for Medical Oncology (ESMO) Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Last updated 2019. Annals of Oncology 30: 1194–1220, 2019. Available from: www.annalsofoncology.org/article/S0923-7534(19)31287-6/pdf (accessed April 2023)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Mike Dixon, Professor of Surgery and Consultant Breast Surgeon.
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