If you are having your breast removed with immediate reconstruction for risk-reduction purposes, it may be possible to preserve the nipple. There are two options for keeping your own nipple:

• The nipple can be left attached to the skin of the breast with just the tissues underneath the skin being removed.
• The nipple and its surrounding skin is removed with the rest of the breast tissue and then attached (grafted) onto the reconstructed breast.

It will not be possible to preserve the nipple if there is any possibility that it may contain cancer cells; you can discuss this with your surgeon who can advise you what your options are.

If it has been decided to remove the nipple during the mastectomy procedure and it is not possible to graft the nipple onto the breast during immediate reconstruction, it is usually possible to have a nipple made later. This is usually done some time (perhaps a few months) after the breast reconstruction has healed and settled into its final shape and position.

An important point to note is that reconstructed nipples have no sensation.

Techniques used

Various techniques may be used for nipple reconstruction:

Local skin flap surgery using a local skin flap creates a nipple shape on the breast. Six to eight weeks later, the nipple and areola (the coloured area of skin around the nipple) are tattooed to give the right colour. More details about tattooing are given further down the page.

Skin graft More rarely, the nipple and areola are reconstructed from grafted skin tissue taken from other suitable areas of your body, such as the skin at the top of the inner thigh or behind the earlobe, which tends to be a darker colour.

While the reconstructed nipple can improve the appearance of your breast, it is important to note that it will not behave in the same way (eg in response to temperature changes) or have the same sensation as a natural nipple.

Silicone stick-on nipples (nipple prostheses)

You may decide that you do not want to have another operation to create a nipple. In this case you could consider nipple prostheses or silicone stick-on nipples, which can be attached to the reconstructed breasts using a special adhesive. These can be bought ready-made, custom-made or can be an exact mould of the original nipple and areola.

The process of making an exact mould of the nipples usually requires two visits to the hospital. The first visit is prior to the breast surgery for silicone colour matching and to make an impression of the nipples and the areolas. These are then hand painted and the second visit is for fitting after surgery. A master nipple is usually retained for future reference.

Silicone nipples can stay in position for up to three months after using a medical adhesive. The life of a nipple is approximately 18 months, but the moulds can be stored for years allowing new ones to be made as necessary.

If you are unsure as to whether you will have nipple reconstruction and surgery, it is possible to have the nipples made in wax and the silicone coloured to match the nipples prior to surgery as a safeguard. These can always be stored and used at a later date if required.

Nipple tattooing

If a local skin flap has been used to create a nipple, tattooing may be used to give the right colour. If the shape of the nipple has not been created with surgery, a tattooing technique can be used to get the effect of a nipple and areola on the breast; this technique will not give the three-dimensional shape of a nipple but it can give a very good appearance. Silicone stick-on nipples can also be used for times when you want the shape of a nipple (eg when wearing a swimming costume).

Nipple tattooing is usually done under local anaesthetic, either using a local anaesthetic cream or an injection. The procedure usually takes 30–40 minutes. A semi-permanent pigment is injected under sterile conditions. The exact colour will depend on your skin colour and the amount injected will be varied slightly from person to person to give the best appearance. Usually the tattooing procedure needs to be repeated to give the best result.

The tattooing itself is not usually painful but the area may feel sore (like a graze) for a few days afterwards. You will probably be advised to wear a dressing over the area afterwards for about a week. This may need to be changed in case the dye leaks through the dressing.