During a mastectomy the whole breast is removed, usually including the nipple, however it may be possible to keep your nipple if you are having removal of all the breast tissue with immediate reconstruction. There are two options for retaining your own nipple.

1. The nipple can be left attached to the skin of the breast and just the tissues underneath the skin are removed (known as a subcutaneous mastectomy).


2. The nipple and its surrounding skin may be removed with the rest of the breast tissue and then attached (grafted) onto the reconstructed breast.

It will not be possible to keep the nipple if there is any possibility that the nipple or the surrounding tissue contains cancer cells.

If the nipple has to be removed during mastectomy or lumpectomy and it is not possible to graft the nipple on to the breast during the immediate reconstruction, it is usually possible to have a nipple made later. This is usually done some time after the breast reconstruction has healed and settled into its final shape and position. This enables the surgeon to position the nipple accurately, in line with the one on your other breast. The time interval between the two operations – for breast and nipple reconstruction – may vary, but is usually about 4–6 months.

Various techniques may be used for nipple reconstruction. Surgery using a local skin flap generally creates a nipple shape on the breast. This can usually be done as day surgery under local anaesthetic. Six to eight weeks later the nipple and areola are tattooed to give the right colour.

More rarely, the nipple may be reconstructed from grafted skin tissue, taken from other suitable areas of your body. Two areas that may be used are the nipple and areola from the remaining natural breast and the top of the inner thigh, where the skin is darker in colour.

It is important to be realistic about what to expect from a reconstructed nipple – it will not behave in the same way or have the same sensation as a natural nipple.

Nipple tattooing is usually done under local anaesthetic, either using a local anaesthetic cream such as EMLA cream or an injection.  The procedure usually takes 30–40 minutes. A semi-permanent pigment is injected under sterile conditions to prevent infection. The exact colour will depend on your skin colour and the amount injected will vary slightly from person to person to give the best appearance. Sometimes the tattooing procedure needs to be repeated to give the best result. A couple of coatings usually lasts approximately 18 months to 2 years. The opposite nipple may need to be tattooed to get a good match.

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.

Nipple tattooing after breast reconstruction can give the reconstructed nipple a very good appearance.

You may decide that you do not want to have another operation to make a nipple. In this case you could have a silicone stick-on nipple, which can be attached to the reconstructed breast. These can be bought ready-made, or made to match your other nipple. The nipple prostheses are usually made in the moulding room at the hospital.