Nipple reconstruction

The nipple is usually removed as part of a mastectomy. But it may be possible to keep it when having an immediate reconstruction. This is called a nipple-sparing breast reconstruction.

Preserving the nipple is usually possible if:

• the risk of the nipple or surrounding tissue containing cancer cells is very low
• you have a suitable breast shape.

There are 2 ways a surgeon may do this:

• The nipples are left attached to the skin of the breasts and the breast tissue that lies under the skin is removed.
• The nipples are removed alone or along with the surrounding darker skin (areola). They are then reattached (grafted) onto the reconstructed breast.

If you are having risk-reducing surgery, another way involves first having an operation to reposition the nipples and reduce the breast skin. This is called a breast uplift or mastopexy. You then have a second operation to remove the breasts through the lower scar under the breasts and the breast reconstruction.

Sometimes the nipple needs to be removed in the weeks after breast reconstruction. This may happen if the blood supply to the nipple is not good enough and the nipple tissue dies.

It may also happen if there are cancer cells found in the tissue removed from near the nipple. 

If you are having risk-reducing breast surgery, samples of the removed breast tissue are examined under a microscope. If there are cancer cells found in the tissue removed under the nipple, it may need to be removed.

If your nipple is removed as part of your surgery, you will usually be offered nipple reconstruction. 

This sometimes happens at the same time as breast reconstruction. But it is usually done as a different operation, a few months afterwards. This delay lets the reconstructed breast settle into its final shape so the surgeon can position the nipple accurately.

The time between operations for breast and nipple reconstruction may vary. It is usually about 4 to 6 months but may be longer.

You usually have nipple reconstruction done under a local anaesthetic. But you may have a general anaesthetic. You can go home the same day.

Your nipple shape may be reconstructed in 2 ways:

• Using a skin flap. The surgeon folds skin onto your reconstructed breast into a nipple shape. They make it bigger than normal. This is because the reconstructed nipple will shrink and usually flattens with time.
• Using a nipple-sharing graft. The surgeon takes part of the nipple from your natural breast and places it on your reconstructed breast.

When you go home, you will have a dressing over the nipple area. This will be removed when you have a follow-up appointment. Your nursing team will advise you about this.

A reconstructed nipple does not react to temperature changes or touch. It does not have the same sensation as a natural nipple and is likely to be numb. It may also not be the same colour as a natural nipple.

The reconstructed nipple needs a good blood supply from the tissue of the reconstructed breast. If the blood supply is poor, the nipple reconstruction may not be successful.

If you do not want to have nipple reconstruction or tattooing, you may choose to have a silicone nipple (nipple prothesis). You can attach it to your reconstructed breast. You fix the nipple to your breast with special adhesive. It can stay in place for up to 3 months.

Ready-made nipple prostheses come in different shades and sizes. You can usually find a good match with your other nipple.

You can also get custom-made nipple prostheses to match your other nipple. This may involve having a mould made of the nipple on your other breast. Colours are then added to the nipple prostheses to match your other nipple as closely as possible. This procedure is only available in some hospitals.