Nipple and Areola Reconstruction

Table of ContentsView AllTable of ContentsOverviewPros and ConsSurgical TimelineReconstruction TechniquesRisks and ComplicationsCostPost-Op CareRecoveryFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Overview

Pros and Cons

Surgical Timeline

Reconstruction Techniques

Risks and Complications

Cost

Post-Op Care

Recovery

Frequently Asked Questions

Mastectomy, or surgical breast removal, is often an important part of treatment forbreast cancer. There are multiple types of mastectomy surgery, and each leaves a different amount of muscle, skin, and fat for potentialbreast reconstruction. There are also different techniques to address your nipple and areola.

This article discusses nipple and areola construction including the pros and cons of the possible procedures, surgical timeline, reconstruction techniques, risks and complications, costs, post-op care, and recovery from the procedure.

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Healthcare provider in operation room holding a scalpel

The first choice with reconstruction begins with your choice of surgery. You have several choices—whether you have a lumpectomyormastectomy, whether you have immediate or delayed reconstruction, or opt forno reconstructionat all (sometimes called “going flat”).

Depending on the location of your cancer, you might be a candidate for a nipple-sparing mastectomy. This procedure is becoming morecommon, and some research has shown it tends to have a higher initial satisfaction rate, with people who have this approach reporting a better quality of life.Breast cancer surgeons and other researchers continue to study the outcomes of different procedures, so future recommendations may change.

Not all surgeons perform or are comfortable with a nipple-sparing mastectomy. You may need to consider a second opinion at a larger cancer center if this is something you wish to consider. If you do not have a nipple-sparing mastectomy, you may choose to have nipple and areola reconstruction as a later procedure if desired.

According to a 2021 study, nipple-sparring mastectomy and immediate reconstruction appear safe from a cancer recurrence perspective.

As with many of the choices you have made with your breast cancer, there are several pros and cons to consider in choosing to have nipple and areola reconstruction. There is no right or wrong decision to be made, only the decision that is right for you. Your healthcare team should have information about your specific situation and the options available to you.

The Pros

The advantages of nipple and areola reconstructionare that the appearance of your breast is as close as possible to the appearance before your breast cancer diagnosis.

The Cons

There are also disadvantages of undergoing nipple reconstruction. These may include:

Typically, nipple and areola reconstruction is performed about three to six months after the primary reconstruction. This allows for optimal healing and the dissipation of post-op swelling. However, the timing can vary considerably based on surgeon and patient preference, as well as the specific techniques used in both procedures.

Your healthcare provider should discuss the expected timeline with you, and be sure to ask any questions you have about how to know the time is right to take the next step.

There are several different ways for a healthcare provider to reconstruct a nipple and/or areola.

Sometimes, tattooing alone is used to create the appearance of a nipple. This can be done to avoid further surgery.

Skin Graft Reconstruction

Thegraft techniquefor nipple and areola reconstruction involves harvesting skin from a donor site separate from the reconstructed breast. The skin graft is then attached to the site of the newly constructed nipple and/or areola.

Common donor sites for areola grafts include the abdominal scar from a flap reconstruction, the inner thigh, or other body areas.For nipple grafts, the person’s remaining nipple is the preferred donor site, since it provides the best skin texture and color match. However, the other donor sites can be quite useful in the case of a bilateral mastectomy (or particularly small nipples).

Skin Flap Reconstruction

In theflap techniquefor nipple reconstruction, the nipple mound is created from a “flap” of skin taken directly from the skin adjacent to the site of the newly reconstructed nipple.

This technique has the advantage of keeping the blood supply intact. It also confines any scarring to the area of the new nipple and areola (as opposed to creating a new scar at the donor site, as with a graft procedure). The flap procedure is somewhat more reliable than the grafting procedure.

Medical Tattooing

The tattooing procedure, called micropigmentation, is usually performed as the final stage of complete breast reconstruction. If surgical reconstruction is selected, that must heal before the tattoo can be done.

This procedure is performed with equipment similar to that used in a tattoo shop. Its main advantage is that it is a relatively quick and simple outpatient procedure that requires no more than local anesthesia and does not create an additional scar. In fact, micropigmentation can camouflage the color and soften the texture of scars left behind after the initial breast reconstruction procedure.

Primarily, this technique simulates the color, shape, and texture of the area surrounding the nipple (called the areola).

For those who do not wish to undergo further surgery after their primary breast reconstruction, the appearance of the nipple itself may be re-created using only tattooing. The obvious disadvantage of this method is that it can only create the optical illusion of texture and dimension, offering no nipple projection. Still, a 2016 study found that loss of projection of the nipple did not decrease satisfaction among individuals who had this technique. This is also the safest technique.

In some cases, your surgeon may recommend using suchfillers as Radiesse or Allodermto enhance nipple projection. In this case, it may also be helpful to look specifically for a surgeon or micropigmentation technician who specializes in creating the most realistic-looking and three-dimensional appearance.

Your surgeon or tattoo technician will mix various pigments to come up with the right color to complement your skin tones and/or to match your remaining nipple. Achieving the perfect shades may require more than one visit, and as with any tattoo, the pigment will fade in time. Therefore, you may need to consider a return visit for a color touch-up.

Your healthcare provider will review the risks for any procedures you are considering.Surgery always has some risk. Some general risks related to nipple and areola reconstruction include:

For those who have radiation therapy before reconstruction, the risk of side effects (nipple necrosis) is higher,and it’s important to talk to your healthcare provider carefully if you are considering or have had radiation therapy.

When to Call Your Healthcare ProviderAfter surgery, call your surgeon immediately if any of the following occur: chest pain, shortness of breath, unusual heartbeats, or excessive bleeding.

When to Call Your Healthcare Provider

After surgery, call your surgeon immediately if any of the following occur: chest pain, shortness of breath, unusual heartbeats, or excessive bleeding.

Federal law requires that most insurance plans that cover breast cancer care (including mastectomies) pay for breast reconstruction.

However, you should always check with your insurance provider regarding the particulars of your coverage before scheduling any surgery. Some insurance plans dictate where you can go for surgery and specific types of procedures that are covered.

If you have been tattooed as a part of your reconstruction, your tattoo will probably ooze a mixture of ink and blood. It is important not to let the tattoo get dry, or to allow excessive friction between clothing and the tattoo during this time.

Because of the blood, the tattoo’s color will appear much darker at first than it will be once it has healed. During the healing period, scabs will form and fall off, revealing the true color of the tattoo. Do not pick at the scab or try to remove it. If removed too early, the scab will take much of the tattooed pigment.

Reconstruction of the nipple and areola is usually an outpatient procedure requiring less than an hour to complete. Most people will have some mild pain or discomfort, which may be treated with mild pain-killer medications, and can return to normal activities within a few days.

As with all surgical procedures, it is important to understand that these guidelines can vary widely based on your health, the techniques used, and other variable factors surrounding the surgery.

It is important to take care not to subject the procedure sites to excessive force, abrasion, or motion during the healing period. Any severe pain should be reported to your healthcare provider.

Scarring and Sensation

If a grafting technique is used, a new scar will show up around the perimeter of the new areola. An additional scar is also created at the donor site.

Regardless of the method used for reconstruction, it is important to be prepared because the new nipple area will not have the same sensation as the nipple of the remaining breast (or the previous natural breasts).

Summary

Nipple and areola reconstruction can be part of breast reconstruction after cancer treatment. Depending on your breast shape and size, cancer treatment, and preferences, there may be several ways to create a nipple and areola for your reconstructed breasts. There are different levels of surgical procedures that can be used. Your healthcare team will discuss your options and the risks and benefits of any procedures you are considering.

A Word from Verywell

As you think of your journey with breast cancer thus far, you may feel a bit overwhelmed and tired. It may be some minor consolation to realize that cancer changes people in good ways. Studies looking at “posttraumatic growth” in people with cancer have found that cancer survivors not only have a greater appreciation of life but tend to be more compassionate towards others.

Reconstructive surgery is a type of plastic surgery. Plastic surgery can be cosmetic (for appearances) or reconstructive (an attempt to repair a health issue). The same surgery may be done for different reasons, so be sure you understand how your healthcare provider is documenting your case.

The goal of nipple and areola reconstruction is to have breasts that look as similar and symmetrical as possible. Some adjustment to nipple and areola size is typically possible. However, skin does not always heal and shrink the same amount for every person, so there can be some irregularities. Your surgeon should discuss expected outcomes with you before surgery.

6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bailey CR, Ogbuagu O, Baltodano PA, et al.Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction.Plastic and Reconstructive Surgery. 2017;140(2):219-226. doi:10.1097/PRS.0000000000003505Wu ZY, Kim HJ, Lee JW, et al.Oncologic outcomes of nipple-sparing mastectomy and immediate reconstruction after neoadjuvant chemotherapy for breast cancer.Annals of Surgery. 2021;274(6):e1196-e1201. doi:10.1097/SLA.0000000000003798Nimboriboonporn A, Chuthapisith S.Nipple-areola complex reconstruction.Gland Surg. 2014;3(1):35-42. doi:10.3978/j.issn.2227-684X.2014.02.06Sisti A, Grimaldi L, Tassinari J, et al.Nipple-areola complex reconstruction techniques: a literature review.European Journal of Surgical Oncology (EJSO). 2016;42(4):441-465. doi:10.1016/j.ejso.2016.01.003Zheng Y, Zhong M, Ni C, Yuan H, Zhang J.Radiotherapy and nipple–areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis.Radiol med. 2017;122(3):171-178. doi:10.1007/s11547-016-0702-xAmerican Cancer Society (cancer.org).Women’s health and cancer rights act.Additional ReadingMota B, Riera R, Ricci M, et al.Nipple- and areola-sparing mastectomy for the treatment of breast cancer.Cochrane Database Syst Rev. 2016;11(11):CD008932. doi:10.1002/14651858.CD008932.pub3Satteson E, Brown B, Nahabedian MY.Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis.Gland Surg. 2017;6(1):4-13. doi:10.21037/gs.2016.08.01

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bailey CR, Ogbuagu O, Baltodano PA, et al.Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction.Plastic and Reconstructive Surgery. 2017;140(2):219-226. doi:10.1097/PRS.0000000000003505Wu ZY, Kim HJ, Lee JW, et al.Oncologic outcomes of nipple-sparing mastectomy and immediate reconstruction after neoadjuvant chemotherapy for breast cancer.Annals of Surgery. 2021;274(6):e1196-e1201. doi:10.1097/SLA.0000000000003798Nimboriboonporn A, Chuthapisith S.Nipple-areola complex reconstruction.Gland Surg. 2014;3(1):35-42. doi:10.3978/j.issn.2227-684X.2014.02.06Sisti A, Grimaldi L, Tassinari J, et al.Nipple-areola complex reconstruction techniques: a literature review.European Journal of Surgical Oncology (EJSO). 2016;42(4):441-465. doi:10.1016/j.ejso.2016.01.003Zheng Y, Zhong M, Ni C, Yuan H, Zhang J.Radiotherapy and nipple–areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis.Radiol med. 2017;122(3):171-178. doi:10.1007/s11547-016-0702-xAmerican Cancer Society (cancer.org).Women’s health and cancer rights act.Additional ReadingMota B, Riera R, Ricci M, et al.Nipple- and areola-sparing mastectomy for the treatment of breast cancer.Cochrane Database Syst Rev. 2016;11(11):CD008932. doi:10.1002/14651858.CD008932.pub3Satteson E, Brown B, Nahabedian MY.Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis.Gland Surg. 2017;6(1):4-13. doi:10.21037/gs.2016.08.01

Bailey CR, Ogbuagu O, Baltodano PA, et al.Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction.Plastic and Reconstructive Surgery. 2017;140(2):219-226. doi:10.1097/PRS.0000000000003505Wu ZY, Kim HJ, Lee JW, et al.Oncologic outcomes of nipple-sparing mastectomy and immediate reconstruction after neoadjuvant chemotherapy for breast cancer.Annals of Surgery. 2021;274(6):e1196-e1201. doi:10.1097/SLA.0000000000003798Nimboriboonporn A, Chuthapisith S.Nipple-areola complex reconstruction.Gland Surg. 2014;3(1):35-42. doi:10.3978/j.issn.2227-684X.2014.02.06Sisti A, Grimaldi L, Tassinari J, et al.Nipple-areola complex reconstruction techniques: a literature review.European Journal of Surgical Oncology (EJSO). 2016;42(4):441-465. doi:10.1016/j.ejso.2016.01.003Zheng Y, Zhong M, Ni C, Yuan H, Zhang J.Radiotherapy and nipple–areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis.Radiol med. 2017;122(3):171-178. doi:10.1007/s11547-016-0702-xAmerican Cancer Society (cancer.org).Women’s health and cancer rights act.

Wu ZY, Kim HJ, Lee JW, et al.Oncologic outcomes of nipple-sparing mastectomy and immediate reconstruction after neoadjuvant chemotherapy for breast cancer.Annals of Surgery. 2021;274(6):e1196-e1201. doi:10.1097/SLA.0000000000003798

Nimboriboonporn A, Chuthapisith S.Nipple-areola complex reconstruction.Gland Surg. 2014;3(1):35-42. doi:10.3978/j.issn.2227-684X.2014.02.06

Sisti A, Grimaldi L, Tassinari J, et al.Nipple-areola complex reconstruction techniques: a literature review.European Journal of Surgical Oncology (EJSO). 2016;42(4):441-465. doi:10.1016/j.ejso.2016.01.003

Zheng Y, Zhong M, Ni C, Yuan H, Zhang J.Radiotherapy and nipple–areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis.Radiol med. 2017;122(3):171-178. doi:10.1007/s11547-016-0702-x

American Cancer Society (cancer.org).Women’s health and cancer rights act.

Mota B, Riera R, Ricci M, et al.Nipple- and areola-sparing mastectomy for the treatment of breast cancer.Cochrane Database Syst Rev. 2016;11(11):CD008932. doi:10.1002/14651858.CD008932.pub3Satteson E, Brown B, Nahabedian MY.Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis.Gland Surg. 2017;6(1):4-13. doi:10.21037/gs.2016.08.01

Mota B, Riera R, Ricci M, et al.Nipple- and areola-sparing mastectomy for the treatment of breast cancer.Cochrane Database Syst Rev. 2016;11(11):CD008932. doi:10.1002/14651858.CD008932.pub3

Satteson E, Brown B, Nahabedian MY.Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis.Gland Surg. 2017;6(1):4-13. doi:10.21037/gs.2016.08.01

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The Pros#

The Cons#

Skin Graft Reconstruction#

Skin Flap Reconstruction#

Medical Tattooing#

When to Call Your Healthcare Provider#

Scarring and Sensation#

Summary#

A Word from Verywell#