For the majority of patients undergoing a mastectomy, the nipple and areola are removed. Therefore, many women choose to undergo nipple reconstruction surgery. After a breast reconstruction surgery, which rebuilds the breast mound, a nipple reconstruction procedure attempts to recreate the darker-colored areola and the elevated nipple. It’s important to note that if your breast cancer was treated with radiation, you are more likely to have post-surgical complications.
Several approaches can be used in the reconstruction of your nipple, depending on the condition of your new breast tissue and your surgeon’s preferences.
Small flaps of skin from your reconstructed breast are folded and sutured together to build a mound that becomes the nipple. The skin is manipulated to give the nipple an elevated appearance compared to the breast mound. Additional skin, fat, or synthetic fillers are sometimes used to make the nipple more erect.
If there isn’t enough tissue to create a nipple from the new breast, your surgeon may use a skin graft. Grafts are usually taken from the abdomen, thigh, the crease of the buttocks, or the groin where legs and torso meet.
Skin grafts have a higher rate of complications after surgery.
Autologous graft/nipple sharing
If the nipple on your unaffected breast is large enough, a portion of it may be grafted onto your new breast. This is called an autologous graft or nipple sharing.
Tattooing is widely used to recreate a natural-looking areola and nipple. Skin grafts may also be used in addition to the tattoo procedure. Women who want to avoid additional surgeries may choose to have only a tattoo. It’s important to note that in this situation the nipple will not be elevated.
Plastic surgeons and their clinical staff perform medical tattooing, but many acknowledge that skilled tattoo artists use three-dimensional techniques to produce a much more lifelike nipple and areola.
Pigments are chosen to match your other nipple. Tattooing is usually performed after nipple reconstruction. Over time, pigments may fade or change. This may make it necessary for you to have the tattoo touched up.
Insurance doesn’t always pay for medical tattooing, particularly if not performed by a healthcare practitioner.
If silicone or saline implants were used to reconstruct your breast, nipple surgery is usually performed after your breast has healed from reconstructive surgery. This usually takes place in about 3 or 4 months. If your breast was rebuilt using skin from your abdomen, your nipple may be reconstructed at the same time or at a later date.
Depending on the technique used, nipple reconstruction surgery may take anywhere from 30 minutes to over an hour.
Serious complications from nipple reconstruction are rare. Occasionally, the new tissue will break down and need to be replaced. The newly reconstructed nipples do tend to flatten over time and may require additional surgery.
Usually, nipple reconstruction is done on an outpatient basis at your doctor’s office using local anesthesia. Check with your surgeon to see what kind of anesthesia will be used in your case. You‘ll want to arrange to have someone to drive you home afterward.
Your doctor will give you instructions on how to prepare for surgery. The following may be recommended:
- Don’t drink or eat for a specific period of time before the procedure.
- Don’t take medications the day of the surgery.
- You may be instructed to wash with an antimicrobial soap the night before or morning of surgery.
- Don’t apply deodorant, lotion, or scented products after you shower.
- Wear comfortable, loose-fitting clothes to your surgery.
While healing, your nipple will be tender and easily injured. It may look more pointed at first, but it will flatten after it heals.
If your nipple was built from a skin graft, a plastic nipple protector may be sewn on to shield it. Your doctor will remove the stitches and nipple protector after about a week.
You’ll be sent home in a surgical bra or sports bra. This will hold the surgical dressing in place. Your surgeon will want you to wear the bra and bandages for a few days. Usually, they’re removed when you have your post-surgical exam.
If you’ve had your nipple and areola tattooed, you may experience some flakiness and crusting for a few days.
Your doctor will advise you how to care for your new nipples. Typically, an antibacterial ointment is recommended.
Use cotton or gauze inside your bra to cushion your new nipples while they’re healing.
Don’t use harsh soaps or scrub your nipples until they’ve healed.
Most insurance companies are required, under federal law, to cover breast reconstruction surgery and prosthetics. This includes the following plans if they started on or after October 1, 1998, and if they cover medical and surgical costs for your mastectomy:
- group health insurance plans and HMOs
- individual health insurance plans not related to your employment
Some states have additional laws that extend coverage.
Although coverage varies, some insurers aren’t required to cover reconstruction.
- government plans
- church plans
- Medicare covers reconstruction, although it’s not required to do so under federal law
- Medicaid coverage varies by state
For insurance policies that are required to pay for breast reconstruction, the following must be covered:
- reconstruction of the breast removed by mastectomy
- internal prostheses, such as saline or silicone implants
- procedures for creating a new nipple or restoring a nipple that was saved during your mastectomy
- surgical procedures to match your other breast to the reconstructed breast
- external prostheses, which are breast forms worn under your bra
Deductibles and co-pays
Keep in mind that with all medical services you may have to meet your yearly deductible amount and co-pays.
It’s always wise to check with your insurance company and your surgeon’s insurance claims staff before having any medical procedures.
Three-dimensional tattooing, which is usually performed in a tattoo parlor instead of a medical doctor’s office, is not typically covered by insurers.