The nipple is often removed as part of a mastectomy. But there are times when the nipple can be kept (preserved). This is usually possible if:
- the risk of the nipple or surrounding tissue containing cancer cells is very low
- you have a suitable breast shape
- you are having an immediate reconstruction.
There are two ways a surgeon may preserve the nipple during a mastectomy:
- The nipple is left attached to the skin of the breasts and the breast tissue that lies under the skin is removed.
- The nipple is removed alone or along with the surrounding darker skin (areola). It is then reattached (grafted) onto the reconstructed breast.
Sometimes the preserved nipple needs to be removed in the weeks following breast reconstruction. This may happen if:
- cancer cells are found in the tissue removed near the nipple
- the blood supply to the nipple is not good enough and the nipple dies.
If your nipple was removed as part of your surgery, you will usually be offered nipple reconstruction. Occasionally this is done at the same time as breast reconstruction. But it is usually done some time 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, but it is usually about 4 to 6 months. Nipple reconstruction is usually done under a local anaesthetic and you can go home the same day.
Your nipple shape may be reconstructed in two 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 may flatten 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.
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.
If you have a new nipple shape made, you can have it and the area around it tattooed. This can be made to match the colour of the nipple and areola of your other breast. This is sometimes called micro-pigmentation.
Sometimes, the opposite nipple is also tattooed to ensure a good match.
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 prosthesis. You can attach it to your reconstructed breast with a special adhesive. It can stay in place for up to 3 months.
Ready-made nipple prostheses come in different shades and sizes. Most women find a good match with their other nipple.
You can also get custom-made nipple prostheses to match your other nipple.