Reconstructing Nipples after Breast Cancer Surgery

If you lose a nipple after breast cancer surgery, a plastic surgeon can reconstruct a nipple. You have alternatives to reconstruction, too.

When a breast cancer patient undergoes a mastectomy, it’s possible their nipple may be preserved. But it depends on how far the nipple and areola (the ring of pigmented skin around a nipple) are from the margins of the cancer tumor and surrounding tissue. However, nipple-sparing mastectomy is only an option for women with very small, early-stage cancer near the outer part of the breast, according to the America Cancer Society. So mastectomy surgery results in most breast cancer patients losing their nipples.

But that doesn’t mean a woman’s reconstructed breast will never have a nipple again.

Thanks to advances in plastic surgery techniques, breast reconstruction after a mastectomy for breast cancer provides more natural looking results than ever before.

Although each case is different and revolves around the stage and type of breast cancer, as well as the patient’s preferences, breast reconstruction can often take place at the same time as a mastectomy. And, after the chest heals from reconstruction surgery and the position of the reconstructed breast has stabilized, a plastic surgeon can then reconstruct the nipple.

“The patient’s oncologist determines whether or not a nipple can be saved during a mastectomy. If the nipple cannot be saved, we can reconstruct it three to six months down the line,” said Atlanta-based plastic surgeon Lisa DiFrancesco, MD, who performs breast and nipple reconstruction for breast cancer patients.

Although surgeons sometimes use skin from other parts of the body — including labia skin to create the darker skin tone of an areola — the vast majority of the time skin from around the breast is used for nipple reconstruction, according to DiFrancesco.

Plastic surgeons reconstruct nipples after breast cancer surgery by cutting and moving a small flap of skin from the reconstructed breast to the nipple site. “We create a pattern for the flap, position it and create a 3-d nipple out of this flap,” DiFrancesco said. “Then we work with medical tattoo artists to color the nipple.”

Most patients are very happy with the results, although it’s important for breast cancer survivors to understand their new nipple is not functional.

“It does not have nerves so sensation in the reconstructed nipple will never return,” DiFrancesco explained. “And it cannot become erect.”

Not every woman opts for nipple reconstruction, even when it is offered. “Fifty percent of women choose not to reconstruct. They don’t want to undergo additional surgery or they have other personal reasons,” DiFrancesco said.

For those who don’t want to undergo surgical nipple reconstruction, there are several alternatives. For example, skilled medical tattoo artists can create the illusion of a 3-D nipple through color variations. In addition, nipple prosthetics can be attached to the breast and worn and removed whenever the woman chooses. They are usually made of silicon and look and feel like real nipples.

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