Nipple reconstruction surgery

In some mastectomies, the surgeon needs to remove the nipple and the area of darker skin around the nipple ('areola').

Some people are happy with how their new breast looks after a mastectomy, without a nipple. Others feel that recreating a nipple will make their reconstruction process more complete.

Nipple reconstruction surgery is an optional procedure after mastectomy for:

• people who have had breast reconstruction surgery
• people who choose to stay flat. 

About the procedure

It is a small procedure, typically performed under local anaesthetic.

Usually, the surgeon takes tissue from around the breast or another part of your body to make a nipple shape. This is a ‘flap’ technique: the tissue is folded and shaped to make it look like a nipple.

There are several ways to recreate a nipple shape and the darker skin area around the nipple (‘areola’). Some are more complex than others. The type of breast reconstruction you had may affect how the surgeon creates the nipple.

The surgery may also involve a small skin graft. The surgeon attaches ('grafts') skin from another part of the body, such as the inner thigh or tummy, to the breast around the nipple.

Nipple reconstruction surgery is often a day procedure. You should not have to stay in hospital overnight.

Side effects of surgery

As with any surgery, there are possible side effects. These may include:

• swelling
• bleeding
• pain
• the nipple flap ‘fails’, meaning the tissue dies due to poor blood supply ('tissue necrosis').

Timing of nipple reconstruction surgery

Usually, any nipple reconstruction takes place at least three months after breast reconstruction surgery.
Your breast needs time to completely heal and settle into a more natural shape. This makes it easier for the reconstructed nipple to best match your other breast.

If both nipples are being reconstructed, the nipples will be positioned centrally on the breast. 

Recovery after nipple reconstruction surgery

Immediately after surgery, your breast may feel uncomfortable. You may need medication ('analgesics') to help with the pain.

It may take several weeks for your wound(s) to heal and any swelling to settle. The nipple can also flatten.

Your surgeon will give you information including:

• how to manage the dressings over your wound
• any restrictions to exercise.

They may suggest you wear a type of nipple protector or special bra during your recovery, until the reconstructed nipple has healed.

How a new nipple will look and feel

The new nipple will have a good appearance but it will not look or feel like your original nipple. The nipple may be the same colour as the skin around it, so some people have tattoos.

Also, the new nipple does not have any nerves, so it won't have any sensation.

Depending on the shape of the reconstructed nipple, it will either be permanently erect, or flat.

The nipple will not respond to touch or become erect in cold temperatures.