After you’ve had breast reconstruction surgery following a mastectomy or lumpectomy, there’s one more possible step. You’ll need to decide if and how you’d like to have your nipple -- and areola, the colored area around it -- reconstructed. This part of the process usually comes about 3 to 4 months post-op, when the new breast mound has healed.
Nipple and areola reconstruction after breast reconstruction can boost your body image and help you adjust psychologically to the many changes in your body. The goal is to make the new breast or breasts look as much like your natural breasts as possible.
Nipple and areola reconstruction seeks to re-create all the features of your natural breast, including the position, size, color, shape, texture, and how far your natural nipple projects outward. Your plastic surgeon might use tissue from your new breast or graft skin from another part of your body. Or, you might opt for nipple tattooing -- an effective, and increasingly popular, way to create gradients of color and a three-dimensional look to match your other breast.
Most reconstruction options are outpatient, meaning you can go home the same day, whether the procedure takes place in the operating room or the surgeon’s office.
Areola and Nipple Graft
This operating-room procedure takes skin from another part of your body to create a nipple and areola. The surgeon will use skin from your chest to make a nipple. For the areola, surgeons usually choose to take skin from an area such as the waist or inner thigh because this skin tends to heal to a darker tone once it’s grafted.
Your nipple will project outward in a natural way. You might also choose to have color tattooed onto the new nipple to match the areola. It’s key to remember that though your new nipple might look like its original, you won’t feel any sensation, and it won’t respond to touch or temperature. You also might find it less pert than before.
Another potential drawback is, although it’s an outpatient surgery, you might feel a bit surgery-weary by this point.
If your natural remaining nipple is large and has projection to spare, your surgeon can use some of it to graft onto your reconstructed breast mound. The upside is the natural match in size, position, and color. An areola can be tattooed later, too.
On the downside, the procedure might damage your original nipple and cause pain and loss of sensation.
The local flap technique uses skin near the surgery site and fat from beneath to make a projected nipple. In this way, the tissue taken brings its blood supply to its new site.
While there are many ways to make local flaps, in the past they’ve all lost some projection -- between 45% and 75% -- down the line, with most happening within 2 months after the procedure. Your plastic surgeon will overcorrect by constructing the nipple about twice the projection desired to account for the expected loss.
Another option to make up for loss of projection is an implanted prosthetic. The surgeon implants a gumdrop-shaped silicone and polyurethane stand-in underneath the local flap. The internal prosthetic helps preserve your nipple projection. But there’s a risk of infection and other complications.
Researchers continue to seek new ways to enhance and extend nipple projection.
Tattooing, technically called intradermal tattooing, is no longer just an option for women who don’t have enough extra tissue for a skin graft. It’s now the most common way to re-create the areola.
A wide range of colors can perfectly match your flesh tone. The tattoo can also make the nipple area darker and create an impressive illusion. Some women prefer these surgery-free 3D techniques and opt out of nipple reconstruction altogether. After all, a breast cancer survivor will have had multiple surgeries by this point. Plastic surgeons often recommend tattoos over nipple reconstruction surgery, too.
Areola tattooing usually doesn’t hurt. Your surgeon or another specially trained practitioner will do the procedure in their office. Your doctor could also refer you to a licensed tattoo artist who can use complex techniques to create very realistic-looking nipple-areola tattoos.
Though a tattoo artist can home in on fine details that surgery doesn’t allow, a 3D tattoo doesn’t have the physical dimension it appears to. This is off-putting to some women. Others prefer it, often because they enjoy how their clothes look without having to rein in their nipples.
As much as 40% of your tattoo can fade within a few years, so you’ll need touch-ups. You also can expect your tattoo to be darker than your desired tone at first. It’ll get lighter in the first few weeks.
If you don’t want to commit to a permanent tattoo, you can choose temporary tattoos. Temporary nipple tattoos are inexpensive, look good, and can be applied with a wet cloth. After a week or two, just remove them with rubbing alcohol and reapply as you wish.
If you don’t want further surgery, a nipple prosthetic is another option. The silicone stand-in will look and feel -- to the touch if not sensation-wise -- like a real nipple. An added plus is, you can put them on and remove them whenever you want to.
You can buy an “off-the-shelf” nipple prosthetic or get a custom-made version. If you want the latter, a prosthetist will make an impression and a mold of your other nipple to create it. You’ll attach the silicone nipple to your breast mound with silicone tape or another adhesive. You’ll also need to take it off regularly so you can clean and care for the skin beneath, then reattach it as you wish.