If your nipple is removed as part of breast cancer surgery you will be able to consider having a reconstruction if you wish. This can be done in several ways, but is not normally done at the time of breast reconstruction, instead being carried out when things have had time to settle down and any other treatments for breast cancer have been completed.
Nipple reconstruction is commonly carried out by lifting and rotating a flap of skin at the central part of your breast before suturing it into shape. Alternatively, if your other nipple is quite large, a ‘nipple share’ operation can be done, taking part of your remaining nipple and attaching it to the other breast. Nipple reconstruction can be done under a local anaesthetic with you awake or a general anaesthetic with you asleep and takes about 30 minutes to perform. You shouldn’t feel much pain after surgery but the reconstructed nipple will need dressings on for about 2 weeks afterwards to protect it. The reconstructed nipple will look larger than the other side at first as we deliberately make it bigger; this is because it doesn’t contain any muscle as your natural nipple does and so over time will get smaller and flatten from pressure from your clothing.
In order to create the appearance of the darker skin around the nipple (the areola) a tattoo can be done. We need to wait for about 3 months after your nipple reconstruction before doing this, and tattooing is carried out at the Royal Free Hospital by a Nurse Specialist. Not all ladies wish to have this done but if you do it is carried out with you awake, using some local anaesthetic cream if needed. It is much like having any tattoo, using a fine needle and pigments to mark the skin and takes about 30 minutes. We will try to match the colour with the other areola and you will be able to discuss the colour you are going to have with the tattooist before it is done. Repeated treatments may be needed to get an even uptake of the colour, and if the colour fades in the future.
In some cases ladies would prefer not to have any further surgery, but just have a tattoo. In this case different colour shades would be used to give the illusion of a projecting nipple even though no nipple reconstruction has been done.
An alternative for ladies who don’t wish to have any surgery or a tattoo would be a silicone stick on nipple and areola. This is moulded from your other nipple, or the size and colour chosen by you if both nipples have been removed. Once made, these silicone nipples will last for several years and will be supplied with adhesive to fix them to your skin.