Most women desire a nipple reconstruction or restoration procedure to complete their breast reconstruction after they have had a mastectomy.
Although nipples created by a plastic surgeon do not have the same sensation or react as natural nipples, they look like natural nipples and can offer women an improved sense of completeness after breast cancer reconstruction surgery.
Women who are interested in nipple reconstruction have a variety of options to consider, including surgical and non-surgical procedures.
Here, Tara L. Huston, MD, FACS, assistant professor of surgery and dermatology, and Janet L. Trabosh, RPA-C, MPH, both members of our Plastic and Reconstructive Surgery Division, answer frequently asked questions about nipple reconstruction.
Q: What is nipple areolar reconstruction?
A: Nipple reconstruction is the recreation of a nipple and/or areola in the most projecting portion of the breast mound. This can be done both surgically as well as non-surgically, depending on the desired outcome.
Q: Can a woman's natural nipple be reattached to her reconstructed breast?
A: Yes and no. There are many nipple-sparing techniques that we can employ on the day of mastectomy to either preserve or reattach the native nipple [see our "FAQs about Nipple-Sparing Mastectomy"]. This must be decided before the operation, and carried out on the day of mastectomy surgery. On the other hand, when the nipple has been removed with a traditional mastectomy, it cannot be reattached months later.
Q: When can a woman have a nipple reconstruction?
A: Nipple-areolar complex reconstruction may be done any time the nipple-areolar complex is missing. This can be after mastectomy, after central lumpectomy (which includes resection of the nipple-areolar complex, but preservation of the breast), after oncoplastic reduction where the tumor is involving the nipple [see our "FAQs about Oncoplastic Breast Reduction"], or after non-cancer operations where the nipple is absent.
Nipple-areolar complex reconstruction may be done any time
the nipple-areolar complex is missing.
Q: Is nipple reconstruction required after breast reconstruction?
A: No, it is not required. Like every aspect of breast reconstruction, it is a personal choice. Nipple reconstruction can be done at any time after the breast mound has been recreated and the blood supply is re-established. This is usually three months after the permanent implants are in place or following flap surgery. There is no time limit on when nipple-areolar complex can be safely performed. Some women have the procedure done as soon as is possible; some wait 5 to 10 years; and a small percentage decide to forgo it altogether.
Q: Why should a woman have nipple reconstruction?
A: A woman should have nipple-areolar reconstruction if she desires to have it. It is meant to complete the reconstruction and give the reconstructed breast as natural an appearance as is possible. Some women will opt for the non-surgical tattoo technique, as opposed to the surgical technique, where a "bump" is created, because they do not want to wear a bra and do not want to have anything showing through their shirts.
The purpose of the non-surgical technique is to have the appearance of a nipple for when the patient is in the shower or looking at herself in the mirror. Although there is no "bump," we can create very natural-appearing three-dimensional tattoos using medical tattooing in our office. This is the best of both worlds for some patients.
Q: Is nipple reconstruction surgery permanent?
A: All surgery is permanent; however, surgically created nipples may flatten and tattoos may fade, necessitating additional procedures to maintain projection and color.
Q: What is the time difference for nipple reconstruction if a patient needs chemotherapy?
A: Nipple-areolar complex reconstruction is performed after the completion of chemotherapy once the patient has recovered. This is usually the last stage in reconstruction, and chemotherapy is completed at an earlier time point shortly after the initial breast cancer surgery.
Q: How long is the recovery from a nipple reconstruction surgery?
A: The recovery is rather quick. Using tattoo, the patient may return to work the following day. Using a flap technique, the recovery will depend upon where the skin graft is taken from. The newly reconstructed breast mound itself is rather insensate at the site of nipple-areolar complex reconstruction, thus discomfort is very minimal.
Most flap techniques require a few days for the initial healing and then back to work. We often recommend a two- to four-week hiatus from intense exercise in order to allow the surgical scars to heal. However, walking is encouraged beginning the evening of the procedure.
3D nipple tattoos give the appearance of the areolar complex
with a projected nipple without the projection.
Q: What are the surgical nipple reconstruction techniques?
A: The nipple itself is made from a local flap using the skin on the top of the breast. The most common techniques are the C-V and skate flaps.
The areola can be reconstructed with a full-thickness skin graft from a site remote on the body, such as the bra roll, a C-section scar, or, lastly, the inner thigh. This circular graft benefits the patient by giving the areola a topography different that the surrounding breast, and it is able to hide some of the transverse mastectomy scar, if one exists.
Q: What is nipple tattooing?
A: We use a tattoo machine to deposit color into the dermal layer of the skin to tattoo on a nipple-areolar complex. We can do this over a reconstructed nipple to add color to the existing nipple and create a surrounding areolar. We can add color and highlights to an existing reconstructed nipple-areolar complex to add color and highlights for an improved look, and we can also create a 3D nipple tattoo.
Q: What are 3D nipple tattoos?
A: 3D nipple tattoos are created using a tattoo technique that gives the appearance of the areolar complex along with a projected nipple without the projection. Therefore, women can have a projected look when they look at themselves in the mirror unclothed, but without the unwanted projection if they would like to eliminate the need for a bra under their clothes
Q: Is nipple reconstruction covered by insurance? Is nipple tattooing?
A: Yes, both surgical and non-surgical reconstruction of the nipple-areolar complex are procedures covered by most insurance companies.
Q: What is the Stony Brook difference with regard to nipple reconstruction?
A: At Stony Brook Medicine, all of our plastic surgeons are board certified in plastic surgery. They are leaders in their field and avid researchers. Some of this research focuses on nipple-sparing mastectomy, patient safety, and surgical outcomes. It allows us to incorporate the most novel surgical techniques with a safe surgical environment in order to provide our patients with the best surgical outcomes. In addition, our team at Stony Brook can provide 3D nipple tattooing, which is the latest technique for patients who are interested in this option.