Nipple Reconstruction

Why consider nipple and areola reconstruction

Nipple and areola (the area surrounding the nipple) reconstruction is the final stage of breast reconstruction, when a nipple is made and the colour replaced to the surrounding areola. Nipple and areola reconstruction is offered to patients who have undergone breast reconstruction.

It is usually delayed until three to four months after the reconstruction and/or any size-adjusting surgery to the opposite breast is complete. This allows for any post-operative swelling to settle and the new nipple to be positioned correctly. However, you may be happy with your breast mound reconstruction and may choose not to have a nipple reconstruction.  

What is involved in this surgery?

• The nipple will be made from the skin of the reconstructed breast. The surgeon will cut out a shape of tissue using the skin on the reconstructed breast and then stitch this skin to make the nipple shape. This will not replace the colour of the areola.
• Tattooing can be used, either alone or together with a nipple reconstruction, to reproduce the colour and appearance of the nipple and/or areola. If you wish to consider this then discuss this with your Breast Care Nurse and she will give you further information.

What are the risks?

All surgery carries some risk.  The following gives the most common problems that can occur:

• There is a small risk of bleeding on the dressing. This is usually only a small amount. If you are concerned contact your Breast Care Nurse.  
• There is a small risk of infection in the wound. If this does happen it may delay wound healing and antibiotic treatment may be required.
• There may be failure of the blood supply to the new nipple. Rarely the tissue that has been used to create the new nipple looses its blood supply and may die. Usually, an alternative method of nipple reconstruction can be offered to you if this happens. If this is happening the nipple will change to a black colour. If you are concerned contact your Breast Care Nurse as soon as possible.  
• The size of the nipple will reduce and will flatten over time. Sometimes it can become very flat and need reconstruction again. The Surgeon will usually create a larger nipple to allow for shrinkage.  

Every effort is made to recreate a similar appearance but the reconstructed nipple will never be a perfect match to the other.

What are the alternatives?

It is your choice whether you decide to have nipple reconstruction. An alternative is to have a nipple and areola tattooed on to your skin. If you wish to discuss this then talk to your Breast Care Nurse and she will be able to give you further information.

You may also wish to have nipple tattooing as part of your nipple reconstruction Your Breast Care nurse will give you further information on this.  However if you choose to have nipple tattooing your first course will be available on the NHS but top up treatments that are usually required,  at some point due to fading of the tattoo, may not be funded by the NHS and your clinician will have to apply for this.  Please discuss this with your consultant/Breast Care Nurse for further details.

The operation

You will be asked to read and sign a consent form. Please feel free to ask any questions that you may still have.

The operation may be carried out either under a local or general anaesthetic. This may be done as a day surgery procedure or you may have to stay overnight. Prior to the procedure, you will be seen by the Breast Care Nurse/Surgeon who will mark up the position of where the new nipple will be, trying to match the other side. The Breast Care Nurse/Surgeon will involve you in this decision.

Post-operative care

You will have a dressing covering the reconstructed nipple. This area should be kept dry until you are advised by the Breast Care Nurse/Surgeon.

• There may be a slight oozing of blood from the area.
• If you notice any change of colour in the nipple, severe pain, swelling or redness please contact the Breast Care Nurse/Hospital for advice.
• You will be given an appointment to see your Breast Care Nurse within one week after the operation. At this appointment the dressing will be removed and the wound checked. You will not have any stitches to be removed.
• You will be offered painkillers while in hospital and given painkillers to take home.
• Healing may take up to two weeks. The scars will be quite noticeable for between three and six months and will fade slowly over the next few months.  

After a nipple reconstruction you should be able to resume your normal activities within a few days.

Further questions

It is important that you are completely satisfied that you have been given all the information you need and that you fully understand the risks and benefits of your surgery, before you sign the consent form. You may change your mind at any time before surgery.

If you require any further information or you are concerned, please talk to your Surgeon or telephone your Breast Care Nurse. You will be able to contact your Breast Care Nurse Monday – Friday 9am – 5pm.

If you have any problems or concerns at any other time contact the ward where you had your surgery.

Data Protection

Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.  

Further information is available via Gateshead Health NHS Foundation Trust website or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].