Nipple Reconstruction

What is nipple reconstruction?

Nipple reconstruction procedures rebuild or reshape your nipple, the raised center of your breast, and areola, the dark skin around your nipple. This procedure usually occurs after a mastectomy and breast reconstruction. A mastectomy is a surgery that removes your breast to treat breast cancer. Often, but not always in this procedure, a surgeon will remove your nipple and areolar (connective tissue) as well. Breast reconstruction surgery reshapes and reforms your breast after a mastectomy. Not everyone chooses to get breast reconstruction surgery or nipple reconstruction surgery after a mastectomy. 

What are the types of nipple reconstruction?

There are different types of nipple reconstruction depending on what you’d like your breast to look like after the procedure. Types of nipple reconstruction include:

• Graft: A skin graft is a surgical procedure that moves skin from one part of your body to another. In this case, it moves skin from a donor site on your body to the area of your breast where your “new” nipple will be. Donor sites may include your abdomen, buttocks or inner thigh. Your plastic surgeon will use the donor skin graft to form and reshape your areola.
• Flap: A skin flap can be helpful in creating a “new” nipple that projects after a procedure to remove it. Your surgeon will take a piece of skin (flap) from your newly reshaped breast and then mold, fold and suture your skin flap into the shape of a nipple. After the surgery, you may choose to get injectable fillers to add definition to the shape of your nipple. 
• Tattoo: A medical tattoo is pigment added to your skin by a needle. On the one hand, a tattoo can add color to your reconstructed nipple and areola. On the other hand, you can get a nipple tattoo on its own if you choose not to undergo surgery. A tattoo alone (without surgery) uses color and shading to create the illusion of a 3D nipple.

While these surgeries recreate the look and shape of your nipple, the feeling in your nipple won’t be the same sensation that you felt before.

Who gets nipple reconstruction procedures?

You may choose to get a nipple reconstruction procedure if you:

• Had a mastectomy.
• Had your breast surgically altered.
• Experienced an injury to your nipple.
• Want to cosmetically change the size and shape of your nipple.

Each person who considers nipple reconstruction surgery has their own reason why they’re looking to undergo the procedure to meet their personal goals.

Why is nipple reconstruction done?

Many people choose to get nipple reconstruction procedures to build their self-confidence. Depending on why you choose this type of treatment, you may not feel comfortable in your skin or being nude, especially if you underwent a procedure that changed your body. If you have a breast cancer diagnosis, you may consider your options as you undergo treatment to remove cancer from your breast. This could involve a mastectomy. Nipple reconstruction is usually one of the final steps of rebuilding the look and shape of your breast after mastectomy treatment. 

What happens before nipple reconstruction surgery?

Before a nipple reconstruction procedure, you’ll meet with a plastic surgeon who’ll provide a consultation. During the consultation, your surgeon will:

• Answer any questions you might have about the procedure.
• Examine your overall health to make sure you’re a healthy candidate for surgery.
• Review your goals and expected outcomes from the procedure.
• Physically examine your breast area and take pictures.

Your plastic surgeon will also schedule the date of surgery, let you know how to prepare for surgery and discuss your expected healing time.

What happens during a surgical procedure?

Your procedure date for nipple reconstruction surgery may be up to four to six months after breast reconstruction surgery. Your surgeon will tell you how to prepare for your surgery during your consultation, which may include taking certain medications or not eating the night before your surgery.

When you arrive at your surgery center, your surgeon will draw on your skin, marking where they’ll make incisions. You’ll most likely be standing for this.

During your procedure, your provider will give you an anesthetic so you won’t feel any pain. You’ll usually be asleep for the procedure, but some procedures only require a local anesthetic to your breast where your surgeon will complete the procedure, if necessary.

The process varies based on what type of surgery your surgeon performs. Your surgeon will make small incisions in your skin to manipulate your skin to take the form and shape of a nipple. They may remove the skin from another part of your body and place it on your breast to form a new nipple.

Surgery can take anywhere from 15 minutes to an hour.

What happens before a medical tattoo procedure?

Some plastic surgeons can do medical tattooing. You may choose to visit a tattoo artist who specializes in nipple tattooing. If you’re not undergoing surgery and only want a nipple tattoo, you’ll still meet with either a plastic surgeon who performs medical tattooing or a tattoo artist for a consultation. They’ll learn more about your expected outcomes, which could include the size, shape and color of your tattoo. They may sketch a depiction of how they’ll make the tattoo look on your body and take measurements.

If you have an image of what you’d like your nipple tattoo to look like, bring those images to your consultation to show to your surgeon or artist.

What happens during a tattoo procedure?

For a nipple tattoo procedure, you’ll remove your clothing above the waist. Your surgeon or tattoo artist will clean your skin. They could use a stencil that leaves an ink outline on your skin. They’ll then ask you to look in a mirror to make sure that outline is where you want your nipple tattoo to be. If you’re not satisfied with where the stencil is on your skin, speak up. Your artist or surgeon can easily move the stencil. Once tattooing starts, you won’t be able to make changes and the results are permanent.

You’ll lie with your back on a table and your head on top of a pillow for comfort. During this time, your surgeon or tattoo artist will use a handheld tattooing device that they dip in ink or pigment and then use to draw on your skin with a small needle. This machine makes a buzzing noise and vibrates. You may feel pin pokes or the sensation of scratching during a tattoo. Your provider will use a clean cloth to wipe away excess ink from your skin in between passes of the needle. If you need to take a break, let your surgeon or artist know and they can give you a few moments to relax.

The tattoo can take up to a couple of hours to complete.

What happens after these procedures?

When your nipple reconstruction surgery is complete, your surgeon will close up any incisions with stitches and wrap your skin in bandages. You’ll move into a recovery room after the procedure until your anesthetic wears off.

If you underwent general anesthesia (you were asleep), you’ll need to have someone drive you home from the surgery center. Nipple reconstruction surgery is an outpatient procedure, and you don’t need to stay overnight in a hospital, but some people might.

For a nipple tattoo, your surgeon or artist will wrap your skin in a bandage or plastic wrap to seal in any fluid or ink that leaks out of your tattoo site. They’ll let you know how long you need to keep your bandages on and what creams or ointments are best to help your tattoo heal. Your new tattoo may be itchy, but try your best not to scratch your tattoo. Think of a tattoo as an open wound. It’s normal for your skin to peel after a tattoo, but don’t pick at your flaking skin. Instead, let it naturally fall off.

What are the advantages of nipple reconstruction?

The advantages of nipple reconstruction surgery include:

• It replaces a lost nipple with a realistic-looking nipple made of your skin.
• The new nipple has your expected shape and dimension.
• It helps you build comfort with your body.
• It gives you confidence.

The advantages of a nipple reconstruction tattoo include:

• You can avoid surgery if you opt for a nipple tattoo only.
• It has the appearance of a 3D nipple but it’s flat.
• You have a short recovery time.
• A tattoo artist can add fine detailing to make the nipple look realistic.

What are the risks of this nipple reconstruction surgery?

There are possible risks associated with any surgical procedure. For nipple reconstruction surgery, the risks are rare but could include:

• Swelling.
• Bleeding.
• Scarring
• Infection.
• Lose its projection or flatten over time.
• Loss of feeling in your breast.
• Necrosis or loss of tissue.
• Nipple placement changes with your body as you age.

How painful is nipple reconstruction?

Nipple reconstruction surgery isn’t painful during the procedure because you’ll be under anesthesia. This puts you to sleep or numbs the area of your body so you won’t feel any pain. You may feel sore after the surgery.

Medical tattooing may be uncomfortable during the procedure. Tattooing uses a needle to inject ink into your skin. This sensation can feel like having your skin poked or scratched along with vibrations from the tattooing device. Your skin may feel sore for a few days after.

How long does a reconstructed nipple take to heal?

After nipple reconstruction surgery, it can take between four to six weeks for your body to heal. Your skin will heal after a nipple tattoo in about seven to 10 days. Your healthcare provider will discuss your healing time, how to help your body heal and what to expect as you recover.

What can I expect when recovering from a nipple reconstruction procedure?

It will take several weeks for your surgical site to heal after a procedure. Follow your healthcare provider’s instructions on when to remove your bandages and what to look out for during recovery. You may notice your nipples are larger or more pronounced than you expected immediately after surgery. This is normal and your nipple will reduce in size as the swelling goes down.

You may choose to wear a nipple protector or a special surgical bra to cover your nipple underneath your clothing as you heal.

During healing, you should avoid rigorous activity for several weeks. Light exercise is usually fine, but check with your healthcare provider before participating in any physical activities.

When should I see a healthcare provider?

Visit your healthcare provider if you experience severe pain, excessive bleeding and swelling after your surgery or a medical tattoo. If your surgical site or tattoo also leaks yellow or white pus, you may have an infection.