Rebuilding the nipple is often the last step in breast reconstruction after a mastectomy, and it is also one of the most challenging. The surgeon must recreate a nipple from skin tissue.
There are several different types of nipple reconstruction surgery. Surgeons will consider the patient’s conditions and personal preferences when advising on the best method.
What to Consider
Your surgeon will attempt to match a new nipple to your remaining one or duplicate both nipples if you have both breasts reconstructed. The position, shape, size, and projection are all considered.
Nipple reconstruction surgery can make the area resemble a natural nipple, but it won’t necessarily give the nipple a natural color. If you want the nipple to have a color similar to a natural breast or both nipples match, tattooing is an option after surgery.
Nipple Tattoo vs. Reconstruction
Nipple reconstruction requires another surgery after your initial reconstruction surgery. If you opt for a nipple tattoo only, you don’t need the extra surgery. If you’ve chosen reconstructive surgery, your chest must heal before getting a tattoo, and it may take three to four months.
A surgeon can form a new nipple using small pieces of skin from the breast. The areola is created using skin grafts from another body part, such as the inner thigh or abdomen. The rebuilt nipple will be slightly raised, much like your natural nipple. This process takes additional surgery, along with new scars and healing time. Once it’s healed, you can move on to tattooing if you desire to add hues and color.
Alternatively, you can choose nipple tattooing instead of the extra surgery, an option if you’ve had breast reconstruction after mastectomy or decided not to have breast reconstruction.
Nipple Reconstruction Surgery
Different techniques are available to obtain the necessary nipple tissue for this surgery. After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple.
A mastectomy that preserves a woman’s nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts.
Types Of Nipple Reconstruction Methods Include:
Skin Flap Reconstruction: A surgeon can raise small skin flaps around the area where the intended nipple location will be. The surgeon will then fold and sew together these skin flaps above the level of the surrounding skin, creating a bump that will become the new nipple.
Skin Graft Reconstruction: Sometimes, a surgeon may use a skin graft, where tissue from another part of your body, such as the inner thigh, stomach, or buttocks, creates the areola. Depending on the amount of available skin tissue, they may be able to construct the nipple from the skin of the breast mound. This procedure works well if there is not enough skin tissue on the breast mound to create both the nipple and the areola (skin graft techniques can best match the color and texture of the natural nipple).
How to Prepare
Nipple reconstruction is usually an outpatient procedure. Because of this, you may not need to do a lot to prepare. Your care team may ask you to stop taking certain medications before the procedure and stop eating and drinking at a given time the previous night. Make sure to get your questions answered by your provider so you feel as comfortable as possible.
Recovery From Nipple Reconstruction Surgery
Your care team will tell you how to care for yourself after nipple reconstruction surgery and provide specific instructions. It’s normal to have some swelling and bruising right after surgery.
• After surgery, nipple protectors cover the incisions for up to two weeks. Avoid bathing in a tub or pool until your care team says you can shower. Your breast area can get wet but try to keep water from directly hitting it and possibly shifting the nipple protectors.
• If a bra is comfortable and fits with your nipple protectors, you can wear it. Or, you can wear a special post-surgical bra.
• A week or two after surgery, you will have a follow-up appointment to check your healing.
• You can resume most normal activities when you get home after surgery but avoid doing anything that makes you sweat or any heavy lifting until after your follow-up appointment.
• Take pain medication as your care team prescribed, and stay hydrated with fluids. Some pain medications can cause constipation, and drinking water can help avoid stomach issues.
Call your doctor right away if:
• Your pain worsens.
• The nipple protectors irritate your skin, and you see redness or discharge.
• You have a fever, nausea, vomiting, shortness of breath, or leg pain.
Nipple Tattoo
Nipple tattooing offers a less invasive alternative to surgery. It is a cosmetic procedure to help recreate an individual’s nipple and a semi-permanent way of replacing color in the nipple-areola region post-breast reconstruction. Small amounts of natural iron oxide pigment are added to the skin to give the areola region a more natural appearance.
An experienced tattoo artist can create images of highly realistic-looking nipples. For those who have undergone a unilateral mastectomy, it is possible to match the color, shape, and texture of the existing nipple.
Some women have said their breasts appear incomplete without nipples or areolas. Tattooed areolas and nipples help women focus less on what is missing and eliminate the constant visual reminder of their cancer journeys. Likewise, women also have reported that it improves intimacy with their partners because it helps partners feel more comfortable with their new breasts. It distracts away from any scarring and leads the eye to a unique focal point rather than just the scars across the breasts.
This procedure typically follows breast reconstruction surgery, but some individuals may use tattooing after nipple reconstruction surgery to add color or make their new nipple or nipples appear more realistic.
Benefits of 3D Tattoos
Nipple reconstruction is a popular choice for many, and some people may decide to get permanent 3D nipple tattoos instead.
While flat to the touch, a 3D nipple tattoo has a more natural raised appearance. The tattoo artist uses shading and color to create intricate details, giving the nipple and areola a multidimensional look. They can even make the illusion of the little bumps typically found on the areola.
This procedure typically follows breast reconstruction surgery, but some individuals may use tattooing after nipple reconstruction surgery to add color or make their new nipple or nipples appear more realistic.
Preparing For a 3d Tattoo
The American Cancer Society (ACS) suggests waiting after breast reconstruction surgery to get nipple reconstruction or nipple tattoos. Some tattoo artists and studios may prefer that you wait 4-6 months after surgery before having nipple tattoos. This gives the new breast or breasts time to heal correctly. Having a visual consultation with the tattoo artist may be necessary for them to confirm that the skin has healed enough.
A person with known allergies may undergo a skin allergy test 24 hours before the procedure. This may involve applying a small amount of pigment to the skin and seeing whether or not there is a reaction.
What To Expect On The Day Of The Procedure
The person should arrive with clean skin on the day of the procedure. Also, the tattoo artist may ask them to avoid applying moisturizer the night before or on the morning of the surgery.
They may also recommend that the person wears a loose-fitting shirt that opens in the front. Some facilities may provide gowns or robes for people to change into.
The tattoo artist may ask the person to sign a consent form or complete a health questionnaire beforehand.
Is Tattooing Painful?
The reconstructed breast will not have the same sensations as before the mastectomy. As a result, the tattooing is not usually painful. However, some people may experience mild discomfort or pain.
What To Expect During The Procedure
A person can expect the entire appointment to take 1–2 hours. Before tattooing, the tattoo artist will discuss the colors, placement, and size with the person getting the tattoo.
If the person has one of their natural nipples, the artist will match the size and color. If the person has had both nipples removed, bringing in a picture from before the surgery may be helpful.
To determine the color, they will look at a palette of pigments, including pinks, browns, purples, tans, and beiges. After mixing the pigments, the tattoo artist will apply a small amount to the skin so that the person can see how it looks in different lighting.
To help decide on the placement, the tattoo artist may use a silicone nipple. They will then draw markings to show the new areola’s location, shape, and size. It can take approximately 30 minutes to tattoo one nipple.
Aftercare and Recovery
Once the procedure is complete, the artist will cover the tattoo area for protection. It usually takes 7–10 days for a nipple tattoo to heal. However, healing can take up to a few weeks for thinner skin. Once the tattoo is complete, the color is typically darker and more intense. The tattoo will slightly lighten as it heals. After 1–2 months, there should be no further color change.
Following the tattoo artist’s aftercare instructions will help the tattoo heal faster. During recovery, a person should avoid chlorinated pools, bathtubs, hot tubs, and direct sun exposure. People can also apply antibacterial ointment to the area to prevent infection.
Potential Benefits And Risks
A person may opt to get a nipple tattoo instead of surgery. This prevents the creation of new scars. In addition, the healing and recovery process is more straightforward than nipple reconstruction.
Some people find that the results are better than if they had undergone nipple reconstruction surgery. This is because the tattoo can include fine details, coloring, and shading that may it look more realistic.
However, similar to getting a traditional tattoo, getting a nipple-areola tattoo carries a few risks, which can include:
• allergic reactions
• infections
• granuloma, which is a small area of inflammation
• keloids, which are raised scars
• dissatisfaction with the final result
Although the procedure is standard and well-tolerated, some people may experience a delayed hypersensitivity reaction, otherwise known as a delayed allergic reaction. A person interested in 3D nipple tattooing should discuss potential risks with a healthcare professional.
Where To Get a Nipple Tattoo
Finding an artist specializing in permanent areola and restorative tattooing is an essential first step to getting a nipple-areola tattoo. Although some individuals may have a tattoo artist in mind, others may ask a doctor, surgeon, or local cancer center for advice or referrals.
Once they have found a potential tattoo artist, the person may find it beneficial to ask to see a portfolio of the artist’s work. They can also ask about the artist’s sterilization practices and whether they have a private room for tattooing.
Who Is Unable To Get 3D Nipple Tattoos? | A Person May Not Be Eligible To Get Nipple Tattoos If They:
• Have damaged skin after undergoing radiation treatments
• Have breast skin that is too thin
• Lymphedema involving the chest
• A history of infections in the area of the breast
Costs Of Tattoo Procedure
• A single nipple tattoo is generally around $350. Two tattoos usually range from $600 to $800.00
• The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires group health plans and individual health insurance policies that offer mastectomy coverage to pay for all stages of reconstruction surgery. This includes any additional procedures a person may need to treat further complications.
• Medicare often covers nipple-areola tattooing, while Medicaid coverage varies from state to state. Insurance may not cover nipple tattooing if an independent tattoo artist performs the procedure.
Other Options
If a person does not want to undergo nipple tattooing or cannot do so, other noninvasive options are available. Different types of nipple coverings include the following:
Prosthetic Nipples
Some women find stick-on (prosthetic) nipples a surprisingly good alternative to nipple reconstruction surgery or nipple tattooing.
You may want to try prosthetic nipples if you don’t like or can’t get nipple reconstruction surgery or a nipple tattoo, are still deciding, or are waiting to finish other procedures first.
Prosthetic nipples are made from soft silicone; you can put them on and remove them whenever you’d like. They are either self-sticking or have a unique skin adhesive that can hold the nipple in place for several days or longer. They look and feel like natural nipples and are available in different sizes, colors, and projections.
Temporary Nipple Tattoos
People apprehensive about getting a permanent tattoo can use temporary nipple tattoos. Temporary nipple tattoos are easy to apply and are removable with rubbing alcohol. Temporary nipple tattoos can last for 1–2 weeks.
Decorative Tattoos
You can go for a natural look or a decorative design, like a flower or heart. The designs are entirely up to you.
Costs and Insurance Coverage
Some insurance companies cover the cost of prosthetic nipples. In most cases, you have to submit the claim to your insurance yourself, with a receipt for the prosthetic nipples and a prescription or a letter from your doctor that states that the prosthetic nipples are medically necessary.
SUMMARY
Many people opt to undergo nipple reconstruction. There are various approaches to reconstructing a nipple using flaps of the patient’s skin. However, healing processes often cause the reconstructed nipple to flatten over time, and it may become completely flat in a year or two. The result can be very disappointing for patients.
Nipple-areola tattooing is a procedure in which a medical specialist or experienced tattoo artist recreates the appearance of a person’s natural nipple. Although flat to the touch, these tattoos appear 3D and realistic. A person interested in 3D nipple tattooing should discuss potential risks with a healthcare professional.
Nipple tattoos after mastectomy are often covered by health insurance. Always check before getting your tattoo.
RESOURCES
BreastCancer.Org
City of Hope
MedicalNewsToday
National Cancer Institute
VeryWel
lHealth
