What to know about nipple reconstruction surgery
After a mastectomy, a person may decide to have breast and nipple reconstruction surgery. Others may have breast but not nipple reconstruction. Other options include wearing a prosthetic breast or simply "going flat."
The choice is entirely up to the individual, assuming that they are healthy enough for reconstruction, and that their tissue has healed well following the mastectomy.
This article covers the different types of nipple reconstruction surgery, how to prepare, and what to expect during the recovery process. We also discuss the potential side effects, complications, and costs.
Types of nipple reconstruction
The type of nipple reconstruction will depend on the size and location of the cancer.
Depending on the size and location of the cancer, as well as the size of the breast, some people have the option to undergo a nipple sparing mastectomy. If a person has a total mastectomy, they may choose to have breast or nipple reconstruction.
During nipple reconstruction surgery, a surgeon will use skin from the breast or another part of the body to rebuild the nipple on top of the breast mound. They will try to build the new nipple to match the size, shape, and color of the original one.
People can speak with their healthcare provider about the potential costs and benefits of this procedure.
There are several different types of nipple reconstruction surgery. Surgeons will take people's condition and personal preferences into account when advising on which method may be best.
Types of nipple reconstruction method include:
Skin flap reconstruction
A surgeon can raise small flaps of skin from around the area where the intended nipple location is to be. They will then fold and sew together these skin flaps above the level of the surrounding skin, creating a bump that will become the new nipple.
According to one 2015 article, nipples that surgeons build using the skin flap method can retract or flatten over time. This is not harmful, but if people choose to, they can have a second procedure to resolve this.
Skin graft reconstruction
To create a nipple from a skin graft, a surgeon will take a small piece of skin from a different part of the body — such as the inner thigh, stomach, or buttocks — to create the areola. Depending on the amount of available skin tissue, they may be able to construct the nipple from the skin of the breast mound.
This procedure works well if there is not enough skin tissue on the breast mound to create both the nipple and the areola.
One 2018 study suggested that skin graft techniques can provide the best match for the color and texture of the natural nipple.
Like in the skin flap method, nipples that surgeons make from a skin graft may become flatter over time.
Once healed, a person may choose to get a medical tattoo over the top of a reconstructed nipple to make it look more natural. This can help create the pigmented areola.
A person can also choose to skip nipple reconstruction surgery and get a nipple tattooed directly onto the breast mound. There have been many recent improvements in nipple tattoo techniques. One example is 3D tattooing, which uses shading and shadow to create the appearance of a raised nipple.
How to prepare
According to the American Cancer Society (ACS), nipple reconstruction surgery usually takes place 3–4 months after breast reconstruction surgery, giving the new breast time to heal.
A doctor may ask the person not to consume any food and water on the night before the procedure. They may also recommend that the person stops taking certain medications for some days leading up to their procedure.
Sometimes, however, a surgeon can perform the procedure using only numbing medicine on the breast.
Following surgery, a person should avoid soaps that contain harsh chemicals.
While the nipple heals, it might look more erect than usual, but it should flatten a little over time. People can also expect some tenderness in the new nipple as it heals.
People may use a plastic nipple protector and a surgical bra to protect the new nipple from injury. A surgeon or nurse will give people specific information regarding:
- how long to wear the bra and bandages
- how to care for and clean the new nipple
- when to return for the postsurgical exam
During recovery, a person should try to avoid using soaps that contain harsh chemicals when cleaning the new nipple. People can apply antibacterial ointment to the healing nipple to avoid infection.
However, it is always best to check with a doctor before using any new medications or ointments.
The ACS list the following possible side effects of nipple reconstruction surgery:
- swelling from fluid buildup in the breast
- infection at the site of the surgery
Although they are rare, compilations can occur following nipple reconstruction surgery. Complications may include:
- nipple flattening or retraction
- changes in the appearance of the nipple or breast
- loss of sensation in the nipple or breast
- changes in the appearance or sensation of the arm
- necrosis, or tissue breakdown
- loss of pigment from nipple tattooing
Costs and insurance coverage
Law requires most private health insurance companies to cover breast reconstruction surgery.
This includes additional procedures to treat any complications that arise.
The WHCRA applies to two types of plans:
- group health plans, such as insurance that employers or unions offer
- individual health insurance policies
Insurance might not cover the cost of nipple tattooing that a nonmedical professional, such as an independent tattoo artist, performs.
Nipple reconstruction surgery involves rebuilding the nipple and areola on top of the breast mound. This procedure usually marks the final phase of breast reconstruction surgery.
A surgeon can use skin from the breast mound, thigh, stomach, or buttocks to form the nipple and areola.
The new nipple may flatten or retract over time. If this happens, people can choose to have another procedure to reshape the nipple.