Nipple Reconstruction Surgery: What You Need to Know

Nipple reconstruction can involve skin grafts, reshaping, or medical tattoos. It’s usually performed after healing from reconstruction. Learn your options for this highly personal surgery.

For many people undergoing a mastectomy, the nipple and areola are removed. Some also choose to undergo nipple reconstruction surgery.

There are several options for reconstructing the nipple. What works for you will depend on your healing process and your surgeon’s skills.

Here’s what to know when making decisions about nipple reconstruction after mastectomy.

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Nipple reconstruction surgery types

There are several types of nipple reconstruction, from surgical to cosmetic. Your options will depend on your aesthetic preferences, the condition of your new breast tissue, and your surgeon’s expertise.

Skin flap

Small flaps of skin from your reconstructed breast are folded and sutured together to build a mound that becomes the nipple.

The skin is manipulated to give the nipple an elevated appearance compared to the breast mound. Additional skin, fat, or synthetic fillers are sometimes used to make the nipple more erect.

Skin graft

If there isn’t enough tissue to create a nipple from the new breast, your surgeon may use a skin graft. Grafts are usually taken from the abdomen, thigh, the crease of the buttocks, or the groin where the legs and torso meet.

Skin grafts have a higher rate of complications after surgery.

Autologous graft/nipple sharing

If not having a double mastectomy, and the nipple on your unaffected breast is large enough, a portion of it may be grafted onto your new breast. This is called an autologous graft or nipple sharing.

Medical tattooing

Tattooing is widely used to recreate a natural-looking areola and nipple. It’s usually performed after nipple reconstruction or on its own. Skin grafts may also be used in addition to the tattoo procedure.

People who want to avoid additional surgeries may choose to have only a tattoo. It’s important to note that tattooed nipples are not elevated.

Plastic surgeons and their clinical staff often perform medical tattooing. However, you may want to go with a skilled tattoo artist who specializes in nipple tattooing. They often use 3D techniques to produce a much more lifelike nipple and areola.

The tattoo artist will choose pigments to match your other nipple (or former nipples if having a double mastectomy). Over time, pigments may fade or change, making it necessary to have the tattoo touched up.

You may also opt to have a decorative design rather than nipples tattooed.

Insurance doesn’t always pay for medical tattooing, particularly if not performed by a healthcare practitioner.

Nonsurgical options

For those who want to avoid another surgery, there are options like nipple prostheses and bras with nipples.

Nipple prostheses are similar to adhesive bras but have a small, raised bump to simulate a nipple. You may even be able to have custom prostheses made to resemble your natural nipple.

When can you get nipple reconstruction, and how long does it take?

If your surgeon used silicone or saline implants for reconstruction, nipple surgery is usually performed once your breasts have healed from reconstructive surgery. This usually takes about 3 or 4 months.

If your breasts were rebuilt using skin from your abdomen, your nipples may be reconstructed at the same time or at a later surgery date.

Depending on the technique used, nipple reconstruction surgery may take anywhere from 30 minutes to over an hour.

How to prepare for surgery

Usually, nipple reconstruction is done at your doctor’s office using local anesthesia.

Your doctor will give you instructions on how to prepare for surgery. They may suggest that you:

• Don’t take some medications on the day of the surgery.
• Wash with an antimicrobial soap the night before or the morning of surgery.
• Don’t apply deodorant, lotion, or scented products after you shower.
• Wear comfortable, loose-fitting clothes to your surgery.

After surgery and recovery

Your nipple will likely be tender and delicate during healing. It may look more pointed at first, but it will flatten after it heals.

If your nipple was built from a skin graft, a plastic nipple protector may be sewn on to shield it. Your doctor will remove the stitches and nipple protector after about a week.

You’ll likely be sent home in a surgical bra or sports bra to hold the surgical dressing in place. It’s best to wear the bra and bandages for a few days. They’re usually removed when you have your post-surgical exam.

Your doctor will advise you how to care for your new nipples. Typically, an antibacterial ointment is recommended. If you’ve had your nipple and areola tattooed, you may experience some flakiness and crusting for a few days.

You can use cotton or gauze inside your bra to cushion your new nipples while they’re healing. Avoid using harsh soaps or scrubbing your nipples until they’ve healed.

Results and complications

Serious complications from nipple reconstruction are rare, but it’s important to be informed about possible outcomes.

Complications

Occasionally, the new tissue breaks down and needs to be replaced. Newly reconstructed nipples also tend to flatten over time and may require additional surgery to correct their shape.

Even rarer is tissue death or necrosis. This occurs when the nipple doesn’t receive adequate blood supply and may require additional surgery to address.

Other possible complications of any surgery include infection, allergic reactions, and poor wound healing.

Aesthetic and sensation issues

It’s also possible that your new nipple may not look well-matched to your natural nipple. It’s difficult for doctors to achieve total symmetry during nipple reconstruction, but highly skilled plastic surgeons may be able to come close.

Personal satisfaction with nipple reconstruction can vary widely, so it’s important to have realistic expectations about what your surgeon can and can’t accomplish.

It’s also important to note that nipple reconstruction will not restore sensation in the nipple.

Nipple reconstruction surgery cost

Most insurance companies are required to cover breast reconstruction surgery and prosthetics under federal law. This includes the following plans if they started on or after October 1, 1998, and if they cover medical and surgical costs for your mastectomy:

• group health insurance plans and HMOs
• individual health insurance plans not related to your employment

Some states have additional laws that extend coverage.

Insurance details

Although coverage varies, some insurers aren’t required to cover reconstruction.

For instance:

• government plans
• church plans
• Medicare (covers reconstruction, but not required to do so under federal law)
• Medicaid (coverage varies by state)

For insurance policies that are required to pay for breast reconstruction, the following must be covered:

• reconstruction of the breast removed by mastectomy
• internal prostheses, such as saline or silicone implants
• procedures for creating a new nipple or restoring a nipple that was saved during your mastectomy
• surgical procedures to match your other breast to the reconstructed breast
• external prostheses, which are breast forms worn under your bra

Deductibles and copays

Keep in mind that you may have to meet your yearly deductible amount and copays.

Before having any medical procedures, it’s always wise to check with your insurance company and your surgeon’s insurance claims staff.

3D tattooing, which is usually performed in a tattoo parlor instead of a medical doctor’s office, is not typically covered by insurers.

Frequently asked questions

Read on to get answers to commonly asked questions about nipple reconstruction.

Q: Do reconstructed nipples look real?

Depending on the skill of your surgeon, reconstructed nipples can look very real.

Some surgeons are even able to conserve your original nipple prior to breast reconstruction, but this depends on a number of factors, including whether cancer has spread to the nipple and nearby tissue.

Q: How long does nipple reconstruction last?

Nipple reconstruction can potentially last for the rest of your life. In some cases, reconstructed nipples experience complications with blood flow and resulting tissue death. In this case, another surgery may be needed.

Tattooed nipples may fade over time and need to be touched up.

Q: How painful is nipple reconstruction?

Nipple reconstruction does not usually involve sensation. Unless your surgeon is able to conserve the nerve tissue from your original nipple, you will not be able to feel your nipple after reconstruction.

Q: Is nipple reconstruction worth it?

For many, nipple reconstruction is a highly desired and important part of breast reconstruction. For others, nipple reconstruction adds another surgery and recovery that just isn’t worth the stress.

This is a highly personal choice that varies from person to person. It’s best to make this decision with the counsel of your medical team and any intimate partners. However, what’s most important is that you’re happy with the outcome of any procedures you undergo.

Takeaway

Nipple reconstruction is an increasingly common way to complete a natural look for reconstructed breasts. There are different options for completing the procedure, and what will work for you depends on your reconstruction outcomes and your surgeon’s abilities.

It’s important to take your time and decide what’s best for you before you undergo this highly personal surgery.