Nipple reconstruction

Sometimes, the nipple and areola (the dark area of skin surrounding the nipple) need to be removed during mastectomy surgery. In these cases, there are nipple reconstruction options that can recreate the physical shape and appearance of the nipple.

Surgeons remove the nipple and areola for different reasons, including:

• Breast cancer that is close to or has invaded the nipple and areola
• A diagnosis of inflammatory breast cancer, which spreads quickly and involves the skin and often the nipple
• A history of smoking and/or past radiation to the nipple, which increase the risk of complications in nipple-sparing mastectomy

Nipple reconstruction surgery rebuilds the nipple and areola using tissue taken from the reconstructed breast. Sometimes, skin from another part of the body is also used. For people who choose it, nipple reconstruction surgery may be the final step in the breast reconstruction process.

Even if you decide to go flat after mastectomy, you can still choose to have nipple reconstruction.

How nipple reconstruction is done

A plastic surgeon can rebuild a nipple by rearranging tissue from the reconstructed breast into the shape of a nipple. Your surgeon may refer to this tissue and its blood supply as a local skin flap.

There are different techniques for recreating the areola, the dark area of skin around the nipple. Here are two examples:

• Skin graft: Surgeons can use a piece of skin from another part of the body such as your inner thigh, buttock, or belly to reconstruct the areola. This is called a skin graft, a piece of skin that does not include its own blood supply. Instead, the skin graft gets its blood supply over time from the reconstructed breast.
• 3D nipple tattooing: A medical tattoo artist can use different-colored pigments to recreate the look of an areola around the surgically reconstructed nipple.

Recovery after nipple reconstruction

It can take 4-6 weeks to heal from nipple reconstruction surgery.

Your doctor will make recommendations on:

• When to remove bandages
• How to care for the surgery site
• Whether to limit physical activity in any way while healing

Timing of nipple reconstruction

Depending on your treatment plan, nipple reconstruction may be done 3-6 months after breast reconstruction. This allows time for the reconstructed breast to heal.

If you choose to have nipple reconstruction after going flat, you may not have to wait as long. “There’s no clear data on this. But once you’ve healed—in maybe 3 months—you may be able to go ahead with nipple recon surgery,” says Sameer A. Patel, MD, FACS, chief of plastic and reconstructive surgery at Lewis Katz School of Medicine/Temple University Hospital and Fox Chase Cancer Center in Philadelphia.

Some surgeons do perform nipple reconstruction at the time of the initial breast reconstruction, but this is rare.

Talk with your breast cancer care team about when you can plan nipple reconstruction surgery after having other breast reconstruction procedures.

Timing of nipple reconstruction with other treatments

Many people who have nipple reconstruction also need other treatments, such as chemotherapy or radiation therapy. These can affect the timing of nipple reconstruction:

• If chemotherapy is part of your treatment plan, doctors usually recommend waiting several months after chemotherapy is finished before having nipple reconstruction surgery.
• If your treatment plan involves radiation therapy, your doctor may recommend waiting 6 months to a year after radiation is complete before having nipple reconstruction. This allows for:
  • Skin healing after radiation
  • Reduced risk of complications, such as wound healing problems
  • Reduced risk of asymmetry (an unbalanced look), because radiation can change the breast’s shape and appearance; this can affect where the nipple will be placed

Non-surgical options

If you prefer not to have nipple reconstruction but still want the look of a nipple, there are non-surgical options:

• Prosthetic, adhesive (stick-on), removable nipples are available at some hospital cancer center boutiques or at online shops. Prosthetic nipples may be made from silicone or other materials.
• 3D nipple tattooing creates the appearance of a physical nipple, even though the skin remains flat. Learn more about 3D nipple tattooing.

Making decisions about nipple reconstruction

Everyone is unique, and not everyone decides to have nipple reconstruction. Some people decide to have 3D nipple tattooing instead. Others decide not to have either. Some people may not want to have another procedure after finishing other surgeries and/or treatments.

There is no rush to decide to have nipple reconstruction surgery. If you are unsure, you can wait months or years after having other breast surgery or surgeries before you have nipple reconstruction surgery.

Below, you can read about benefits and risks of having nipple reconstruction surgery.

Benefits of nipple reconstruction

Benefits of nipple reconstruction may include:

• Replacing a nipple that was removed with one that looks like a natural nipple
• Ability to change the size and shape of your original nipple
• Restoring a sense of wholeness and comfort with one’s body

Risks of nipple reconstruction

Risks of nipple reconstruction include:

• Nipple reconstruction adds more surgery and recovery time after having other surgeries and/or treatments.
• A reconstructed nipple does not change size or shape in response to arousal or temperature changes
• If there is not enough blood supply to the new nipple, there is a risk of tissue loss, or necrosis.
• The nipple may shift position as you grow older.
• The new nipple will be numb.
• Over time, a reconstructed nipple can sometimes flatten (lose projection). Because of this, many people decide to have 3D nipple tattooing instead of surgical nipple reconstruction.

Benefits of not having nipple reconstruction

There are advantages of not having surgical nipple reconstruction, such as:

• Less surgery
• Fewer risks and complications because of surgery
• No concerns about changes in nipple position as you age