If your nipple was removed as part of your surgery, you will usually be offered nipple reconstruction. Nipple reconstruction is usually done 4 to 6 months after breast reconstruction.

Preserving the nipple

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.

Bilateral nipple sparing mastectomies with implants

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.

Nipple reconstruction

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.

LD flap with implant and nipple reconstruction

Nipple/areola tattooing

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.

Sensation

A reconstructed breast does not have the same sensation as a natural breast. Most women do not feel any discomfort when the tattooing is being done. If you have feeling in the nipple area, they can give you a local anaesthetic cream to numb it.

Tattooing session

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.

3D tattooing

Some units 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 prosthesis

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.

A woman with a nipple prosthesis

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.

About our information

  • References

    Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    European Society for Medical Oncology. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology 26 (supplement 5): v8–v30. 2015.

    Morrow M, et al. Chapter 79: malignant tumors of the breast. DeVita, Hellman and Rosenberg’s cancer: principals and practice of oncology (10th edition). Lippincott Williams and Wilkins. 2014.

    National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. July 2018.

    Scottish Intercollegiate Guidelines Network. SIGN 134. Treatment of primary breast cancer: a national clinical guideline. September 2013.


  • Reviewers

    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, Dr Rebecca Roylance, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.


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