As part of the treatment of breast cancer, the whole breast may be removed including the nipple and areola (the darker flat circular area surrounding the nipple). During reconstruction, the breast mound is created first. About 3 to 4 months after the wounds have healed and when the shape of the reconstructed breast has settled, the nipple and areola complex can be reconstructed. However, you may be happy with your breast mound reconstruction and may choose not to have nipple reconstruction.
Your surgeon will discuss what options are available after your type of reconstruction. Methods include:
- Moulded plastic prosthesis: You may buy ready-made stick-on nipples over the internet. A very realistic nipple areola complex, matching with the other side can be custom-made as a stick-on prosthesis. However, sticking the prosthesis on can sometimes be tricky and this service is not currently available at The Christie. If you are interested in this service, we can give you further advice.
- Tattooing of the nipple and areola: By varying the colour in the tattooing a shading effect can be created which can produce a 3-dimensional appearance of a nipple. However, the tattoo may fade over time and need to be redone. There will be no projection through clothing.
- Surgical nipple reconstruction: It is sometimes possible to create the nipple projection with skin from the breast area (skin flaps). Once the wound is healed the areola is recreated with medical tattooing. Sometimes the areola can be reconstructed using part of the areola from the other breast. This is possible when there is a large areola on the other side.
Consultation with your surgeon
Your surgeon will discuss the risks and benefits of the 3 options with you. If you decide to go ahead with surgical reconstruction, a date will be arranged for this to be done in the surgical theatre, usually under local anaesthesia as an outpatient day procedure. We will ask you to read and sign a consent form for the operation.
Surgery for nipple reconstruction
Before you have a local anaesthetic, the surgeon will mark the correct position of the new nipple on the breast skin, trying to match with the other side. A circular sticker is put on this area. The surgeon will ask you to look in the mirror and make any adjustment until you are happy with the location.
The surgeon marks the skin flaps on the breast and gives the local anaesthetic. You will lie on your back during surgery. All aseptic and antiseptic precautions will be taken.
- You will have a dressing over the operated area. Usually the reconstructed nipple is left visible through a hole in the dressing. Try to keep the area dry for the first 24 hours. After this, you can take a shower but gently pat the area dry.
- There may be a slight oozing of blood after the surgery. Press the area gently with a clean tissue paper for 5 minutes. Usually the oozing stops in 5 to 10 minutes. If bleeding continues, contact The Christie (phone numbers below).
- If you notice any change in the colour of the nipple, severe pain, marked swelling or redness contact The Christie for advice (phone numbers below).
- Your treating team will give you an appointment for the outpatient dressing clinic in 1 week, when the dressing will be removed and the wound checked. If you have any sutures (stitches) that need removing, these will be taken out. The healing may take up to 2 weeks. The scars will be quite noticeable for 3 to 6 months and then fade slowly. Massaging a moisturising cream over the scars 2 or 3 times a day may help this. Around this time, a date will be arranged for recreation of the areola by medical tattooing.
Benefits and risks
On the whole, the nipple reconstruction with surgery is a very satisfying procedure and most patients are pleased with the result.
- As in any surgical procedure, there is a small risk of bleeding or infection.
- Very rarely the skin flaps may not survive, resulting in loss of the nipple.
- It is very difficult to match the 2 nipples exactly and usually some difference persists.
- The nipple projection always flattens to some extent in time. Sometimes it can flatten significantly and may need reconstruction again.
If you have any concerns, please contact us on:
During the day
- Surgical secretary to Mr Lambe – 0161 918 7455
- Clinical nurse specialists – 0161 918 2196
- Plastic surgery nursing office – 0161 918 7586 or 7587
After 5pm and at weekends
Call 0161 446 3000 and ask the switchboard to bleep the on-call surgical senior house officer (SHO) or surgical oncology unit (department 4) on: 0161 446 3860 or 3862.
You can also contact The Christie Hotline on 0161 446 3658 (24 hours a day, 7 days a week).