During a mastectomy or double mastectomy, the nipple is usually removed. One option to remedy this is to have nipple-sparing mastectomy. However, if you are not a candidate for this, you may want to look into whether getting your nipple reconstructed is more ideal for your situation. While nipple reconstruction surgery is a great option, it may not ideal if:
- You’ve had radiation treatments which damaged your breast skin
- Your breast skin became too thin due to the mastectomy
- You have lymphedema of the chest
- You have a history of infections in the breast area
It’s usually advised to wait for around 4 months following breast surgery to have your nipples reconstructed to allow your breast to heal and to settle into a final position. Waiting also ensures that you are happy with the reconstructed breast(s). To ensure you wait for the appropriate length of time in your specific case, speak to your healthcare team about how long you should wait. Also speak to them about whether you can get nipple reconstruction surgery. Once you have been giving to the ok to get your nipples reconstructed and you have been told how long to wait, your next question to your healthcare team should be what you should do to prepare for the surgery. In addition to speaking to your primary healthcare team, you should also speak to the plastic surgeon who will perform your nipple reconstruction. Some questions and topics to discuss with them include:
- How many nipple reconstruction surgeries they’ve performed
- Which technique they use and which they will be using with you
- If they have before and after pictures of the nipple reconstruction surgeries they’ve done
- The size of nipple you want
- An explanation of how the surgery will be done, what to expect, and aftercare
In most cases, nipple reconstruction surgery is a day surgery and is performed under local anesthetic, unless your healthcare team and you decide that general anesthetic is better. The surgery can take anywhere from 15 minutes to an hour to perform. Plastic surgeons may use a variety of techniques to reconstruct your nipples, including:
Using surrounding skin – Small cuts are made in the skin where the near nipple will be. The tissue is near shaped into a nipple and secured with stitches. This is the most common technique.
Skin graft – The new nipple is created with skin from another body part. When this is done, local anesthetic will also likely be used on the area that the skin graft is taken from. This technique has higher rates of post-surgery complications
Nipple sharing (nipple only) – If you had only one breast removed during your mastectomy and the nipple on the unoperated breast is large enough, part of the nipple is taken and used to create a new one. This technique results in the best matching of the two nipples.
Regardless of the technique that the plastic surgeon uses, the reconstructed one is usually made to the larger than the desired size because it will flatten and lose its projection over time. Other considerations to keep in mind when you are trying to decide whether or not to have your nipple reconstructed are:
- It’s additional surgery
- The reconstructed nipple will not look or feel like your original nipple
- There will likely be no sensation in the reconstructed nipple
- There are some risks, including
- Necrosis - If the tissue that was used to create the nipple doesn’t get enough blood, it can die. Depending on the extent of this, the tissue might be trimmed, treated or the nipple might have to be removed
- Poor positioning
In most cases where nipple flattening, necrosis, or poor positioning happen, the nipple can be reconstructed again. Speak to your healthcare team and the plastic surgeon who performed your reconstruction for next steps to take if you would like to have the surgery redone. Once your nipple reconstruction surgery is complete and healed, you may consider getting a 3D tattoo to make your nipple and areola appear more realistic.
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