How is Nipple Reconstruction Done?

If you choose to surgically reconstruct the nipple, there are several options. One common option is to use the skin of your reconstructed breast. The surgeon can take a small flap of skin from the breast, and "cone" it into a new nipple. Because the nerves aren't connected in the reconstructed breast, most women do not feel much pain with this surgery.

Options to reconstruct the areola involve taking skin from a different part of the body and sewing it to the new nipple on the reconstructed breast. The surgeon can take an oval of skin from the outer edge of your mastectomy scar or from the edge of the TRAM donor scar on your abdomen (if you have this kind of breast reconstruction). The advantage of using this skin is that you won't have any new scars. The surgeon can also take skin from the inside of your thigh or from just below your hip bone. You may be sore for up to two weeks at the place from which the skin was taken. However, most women have very little discomfort at the site of the reconstructed nipple. Another option is to reconstruct the nipple as described above and have the skin around it tattooed to a darker color to make an areola.

In all procedures, you will not have much or any feeling in the new nipple when it is touched. These surgeries can be done on an outpatient basis in under two hours, with local or general anesthesia. Most doctors will ask you to wait a week after the surgery before driving or working.

After you have healed, you can have the new nipple and areola tattooed to match the color of your other nipple. Often it takes two or three sessions to color the whole area evenly. Tattooing takes about an hour and can be done in the doctor's office. You can usually go back to work the same day. Most women can hardly feel the tattooing being done. However, your doctor may use a local anesthetic just in case.

When Can I Have Nipple Reconstruction?

Most plastic surgeons do not schedule nipple reconstruction until at least three months after breast reconstruction. You want to allow time for the swelling from the surgery to go down and for the breast to "settle." This allows the surgeon to place the nipple so that it matches the position of the nipple on the other breast. In some circumstances, the plastic surgeon can perform nipple reconstruction at the same time as reconstruction of the breast itself. You may want to discuss this option with your provider.

Advantages of Nipple Reconstruction:

• Your reconstructed breast will match your natural breast more closely.
• You can go bra-less and have the shape of the nipple on both sides.

Disadvantages of Nipple Reconstruction:

• It is usually an additional surgery and requires another recovery period.
• If the skin is taken from a place where there is no scar, you'll have a new scar at the donor site.