Nipple Reconstruction Surgery and Nipple Tattoos

[ad_1]

If one or both of your nipples were removed when you had a mastectomy, you can in most cases choose to have surgery, tattooing, or both to recreate the nipple and the areola (the dark area around the nipple). Some people find that having their nipples reconstructed or tattooed is an important final step in the breast reconstruction process. Others don’t. The choice is completely up to you and you can take your time to decide.

Plastic surgeons usually recommend waiting at least 4 months after breast reconstruction surgery to have nipple reconstruction or nipple tattoos. This will give your breasts time to heal and settle into a final position. It’s also best to wait until you’re fully satisfied with the rest of your reconstruction.

Rarely, some surgeons may offer the option of performing the nipple reconstruction as part of breast reconstruction surgery (rather than as a separate surgery). This is generally not recommended because it can result in poor positioning of the new nipples.

Comparing options:

Nipple reconstruction surgery is usually an outpatient procedure that uses skin from the area of the breast where the nipple will be located to form a new nipple. Later, the reconstructed nipple may be tattooed to add color and to create the areola.

The main advantage of getting your nipple reconstructed with surgery is that it will project out from the breast. Some women feel this creates a more natural look.

The disadvantages are that it involves surgery at a point in the reconstruction process when you might not feel like having more surgery and it carries some minor risks. Also, a reconstructed nipple will flatten and lose most of its projection over time.

Nipple reconstruction can give you a good cosmetic outcome, but a reconstructed nipple won’t look and feel like your original nipple. It’s also important to know that most women lose sensation in their breast area after mastectomy and breast reconstruction, so you likely won’t have sensation in your reconstructed nipple either.

3D nipple tattoos are real tattoos, applied with needles that insert pigment into the skin. An experienced nipple tattoo artist can create an amazingly realistic image of a nipple that appears to have physical dimension but is really flat to the touch. In recent years, a growing number of people have been opting for 3D nipple tattoos instead of nipple reconstruction surgery. Also, plastic surgeons often recommend 3D nipple tattoos instead of nipple reconstruction surgery. Nipple tattooing can also be done to enhance the results of nipple reconstruction surgery.

Some of the advantages of choosing tattooing alone are:

avoiding a surgery and the creation of new scars
an easier healing and recovery process
a tattoo artist can add fine details and coloring to the nipple and areola that can’t be done with surgery

While some women may consider it a disadvantage that a 3D nipple tattoo has no physical dimension, others say they’re glad that they can skip wearing a bra and that their nipples don’t show through their clothes.

women who’ve had breast reconstruction with an implant or tissue flap are candidates for nipple reconstruction surgery or nipple tattooing. But you may not be a candidate if:

radiation treatments damaged your breast skin
your breast skin became overly thinned when tissue was removed during the mastectomy
you have lymphedema that involves the chest
you have a history of infections in the breast area

Prosthetic nipples are another option. If you can’t or don’t want to get nipple reconstruction surgery or a nipple tattoo, or are still deciding, you can always try stick-on (prosthetic) nipples or temporary nipple tattoos. Custom-made prosthetic nipples can look just like natural nipples and you can put them on and take them off whenever you’d like.

On this page, you can learn about how to prepare and what to expect if you have nipple reconstruction surgery or a nipple tattoo, how to use and where to buy stick-on nipples and temporary tattoos, and more.

Learn more about:

Nipple Reconstruction Surgery

Finding a plastic surgeon for nipple reconstruction surgery
Nipple reconstruction techniques
What to expect during and after nipple reconstruction surgery
Nipple reconstruction surgery risks
Paying for nipple reconstruction surgery

Nipple tattoos

Finding a qualified nipple tattoo artist
What to expect during and after nipple tattooing
Paying for nipple tattoos
Prosthetic nipples and temporary nipple tattoos

Article Summary show

Nipple Reconstruction Surgery

Finding a plastic surgeon for nipple reconstruction surgery

Most plastic surgeons who do a lot of breast reconstruction surgery have experience with nipple reconstruction. However, plastic surgeons vary in their level of skill and expertise when it comes to the procedure. It makes sense to choose a plastic surgeon who has done a lot of nipple reconstruction surgeries and has a track record of getting good results. You may decide to have your nipple reconstruction surgery performed by the same surgeon that did your other reconstructive procedures, or by a different surgeon. Ask plastic surgeons you are considering for nipple reconstruction questions like:

How many nipple reconstruction surgeries have you performed?
Which technique do you use?
Can I see before-and-after photos of your nipple reconstruction surgeries?

Nipple reconstruction techniques

There are a number of techniques plastic surgeons use for nipple reconstruction. For example:

Building a new nipple with surrounding skin: This is the most common approach. To create the nipple, the plastic surgeon uses skin from the area on the breast where the new nipple will be located. This involves making small incisions, forming the tissue into a nipple shape, and securing it with stitches. The areola may be created later by tattooing.
Building a new nipple with surrounding skin and an areola with a skin graft: To create the nipple, the plastic surgeon uses skin from the area on the breast where the new nipple will be located. To create areola, the surgeon uses skin from another part of the body, such as the edge of a healed mastectomy scar or a C-section scar, or from some loose skin on the lower belly.
Nipple sharing: If you have a mastectomy on only one breast and the nipple on the other breast is large enough, the plastic surgeon can take a portion of the remaining nipple and use it to build a new nipple on the reconstructed breast. This approach can allow the surgeon to match the new nipple to the natural nipple in size, color, and position. The areola may be created later by tattooing.

Whichever technique is used, the surgeon will usually try to create a reconstructed nipple that is larger than the final desired size. This is to compensate for the fact that the reconstructed nipple will flatten over time.

Before having your nipple(s) reconstructed, talk with your plastic surgeon about the nipple size you want and make sure you understand how the reconstruction surgery will be done.

What to expect during and after nipple reconstruction surgery

Nipple reconstruction surgery is usually an outpatient surgery, which means that you don’t stay overnight in the hospital. Still, some people have an overnight stay at the hospital if they have nipple reconstruction at the same time as another surgery. Your doctor will give you a list of instructions on how to prepare for the surgery.

Your surgeon will draw markings on your breast (and on another area of your body if a skin graft is being used) to show where the incisions will be made. You’ll probably be standing up while this happens.

Nipple reconstruction is often done under local anesthetic. This means that your doctor will use a needle to inject numbing medicine into the area where the reconstructed nipple will be. If you have local anesthetic, you will be awake during the procedure.

If your doctor is taking skin from another place on your body to reconstruct the nipple, that area will be numbed with local anesthetic, too. Only a small amount of skin is needed to recreate the nipple.

If you and your doctor decide that nipple reconstruction surgery should be done under general anesthesia, an intravenous infusion (IV) line will be inserted into your hand or arm and taped in place. You’ll be given relaxing medication through the IV line.

After the surgery, a nipple shield (a protective covering shaped like a tiny hat with a wide flat brim) or other protective dressing is taped over the reconstructed nipple. It may be filled with antibacterial ointment.

The length of nipple reconstruction surgery can range from 15 minutes to an hour or so.

If you’ve had local anesthesia, you’ll be able to go home after the protective dressing is in place. If you’ve had general anesthesia, you’ll be moved to a recovery room after surgery, where hospital staff will monitor you. Once you’re awake and your doctor has checked your heart rate, body temperature, and blood pressure, you’ll be allowed to go home.
Your doctor will give you specific instructions to follow for your recovery, including how to care for the protective dressing and stitches. The protective dressing is usually left on for about 3 days to a week. After it’s removed you can shower.

Because of the lack of sensation in the breasts after mastectomy, you probably won’t feel much pain or tenderness in the nipple area after surgery. If skin was grafted from another part of your body, that area is likely to feel tender or painful for a week or two. Ask your doctor for medicines you can take to ease any pain you may have.

Don’t be discouraged by the initial appearance of your new nipple(s). They may look larger and more pointed than you expected, red and swollen, with visible incisions. As the nipple(s) heal, they will start to shrink and look more like you expected.

Between 4 to 6 months after nipple reconstruction surgery, you can have tattoos applied to the reconstructed nipple(s) and areola(s) to add color and make them appear more realistic, if you wish. (See below for more information on nipple tattooing).

Nipple reconstruction surgery risks

Like all surgeries, nipple reconstruction carries some risks. Here are the most common:

Tissue breakdown: When the tissue used to reconstruct the nipple doesn’t get enough blood, some of the tissue can die. This tissue breakdown is called “necrosis.”

If necrosis occurs, your plastic surgeon will have to trim away the dead tissue. If you have just a small amount of tissue necrosis — for example, if only the tip of the nipple is affected — then you might only need basic wound care after the dead tissue has been removed. But if the tissue breakdown is more extensive, you may need to have the nipple removed.

In most cases, you can have the nipple reconstructed again.

Nipple flattening: It’s common for a reconstructed nipple to lose much of its projection over time. If you’re bothered by how much your reconstructed nipple has flattened, your surgeon may be able to redo the nipple reconstruction.

Usually this will involve making small incisions, forming the tissue into a nipple shape, and securing it with stitches. The surgeon may also add a rolled-up piece of acellular dermal matrix material (a soft tissue substitute made from human or animal skin), or a skin, cartilage, or fat graft from another part of your body to help ensure the nipple will project out from the breast and reduce the risk that it will flatten again.

Poor positioning: There is a small risk that you may not be happy with the position of the new nipple(s) once they heal. This is more likely to occur if your surgeon performed the nipple reconstruction during the breast reconstruction surgery rather than as a separate surgery.

In some cases, you can opt to get another surgery to reposition the nipple(s) on the breast. The plastic surgeon will make a number of incisions and move the breast skin to reposition the nipple(s). The nipple(s) will remain attached to the underlying skin.

It’s important to know that your plastic surgeon may not be able to move a reconstructed nipple that has already been tattooed. If you had one nipple reconstructed and kept one natural nipple, and they’re not symmetrical, it may be easier for your plastic surgeon to move the natural nipple than the reconstructed one.

Paying for nipple reconstruction surgery

In the United States, your health insurance plan should cover nipple reconstruction if it also covers breast reconstruction. The Women’s Health and Cancer Rights Act of 1998 requires all group health plans and health insurance companies (including HMOs) that pay for mastectomy to also cover reconstructive procedures. Medicare generally covers breast reconstruction procedures including nipple reconstruction, while Medicaid coverage can vary from state to state.

Still, it’s not unusual to have some challenges with getting your health insurance to cover nipple reconstruction. Nipple reconstruction is usually performed and billed separately from your other reconstructive procedures and requires a separate insurance authorization.

Before the nipple reconstruction surgery, work with your health insurance provider and your plastic surgeon’s office to find out what you need to do to get your claim approved. You and your plastic surgeon may need to make the case to the insurance company that nipple reconstruction is a medically necessary part of breast reconstruction and not just cosmetic. You’ll also want to find out in advance exactly what will be covered and what you’ll need to pay out of pocket.

Learn more about Paying for Reconstruction Procedures.

Nipple tattoos

A 3D nipple tattoo is a “picture” of a nipple and areola on the breast that is flat to the touch but looks three-dimensional and quite real. 3D nipple and areola tattoos are real, permanent tattoos, applied by a skilled tattoo artist with needles that insert pigment into the skin.

Many women choose to get permanent 3D nipple tattoos instead of nipple reconstruction surgery. A nipple tattoo is less invasive than nipple reconstruction and some people feel that the cosmetic results are better. A tattoo can have fine details, shading, and coloring that make it look more realistic than what can be done with surgery. For example, a tattoo can create the illusion of Montgomery glands (little bumps that naturally appear on the areola).

Tattooing is also used after nipple reconstruction surgery to add color to the new nipple(s), making them look more realistic and creating the appearance of areola(s).

Ideally, nipple tattooing should be the last stage of the breast reconstruction process. It should occur at least 4 months after your last breast reconstruction procedure or at least 4 months after nipple reconstruction surgery.

Nipple tattoos are usually applied in one session at a plastic surgeon’s office, a hospital, or a nipple tattoo artist’s studio. If you’re thinking of getting a nipple tattoo at the studio of a nipple tattoo artist (and not at your plastic surgeon’s office), be sure that your plastic surgeon has given you approval first to move forward with nipple tattooing.

The color of the tattoo may fade slightly over time, and you might want to get a touchup session at some point.

As with nipple reconstruction surgery, you may not be a candidate for nipple tattoos if:

you had radiation treatments that damaged your breast skin
your breast skin became overly thinned when tissue was removed during the mastectomy
you have lymphedema that involves the chest
you have a history of infections in the breast area

If you’re wondering if you can get nipple tattoos, talk with your plastic surgeon and an experienced nipple tattoo artist about your individual situation. Sometimes you may just need to wait longer — for example, for your breast skin to heal more — until you can get nipple tattoos.

Finding a qualified nipple tattoo artist

Nipple tattoos can be done by staff members at a plastic surgeon’s office (such as a nurse, physician assistant, or plastic surgeon) or by a specialized nipple tattoo artist. In general, you’ll get the best results with a nipple tattoo artist because they have the most training and experience.

Ask your medical team if they can recommend a nipple tattoo artist who has worked with a lot of women who had breast reconstruction. The tattoo artist must be knowledgeable, for example, about the factors involved in tattooing skin that has scars. Always ask to see photos of the work of a nipple tattoo artist you are considering.

Nipple tattoo artists may work out of their own studio and also travel to provide tattoos at plastic surgeons’ offices and hospitals in their region and in other locations.

Here are some tattoo artists in the United States who specialize in nipple and areola tattooing:

The Vinnie Meyers TeamThis team of tattoo artists provides nipple tattoos in a shop in Finksburg, MD and travels throughout the year to offer nipple tattoos in other locations such as Boston, MA; Hoboken, NJ; New Orleans, LA; Plano, TX; Austin, TX; Birmingham, AL; and San Diego, CA.Sauler Institute of Tattooing/Mandy SaulerMandy and her team of tattoo artists provide nipple tattoos at their offices and in plastic surgeons’ offices in several locations in Pennsylvania, New Jersey, and New York City.NMR Tattoo/Nicole RizzutoNicole provides nipple tattoos at New York Breast Reconstruction and Aesthetic Plastic Surgery in Great Neck, NY.Pink Ink Tattoo/Tara WilliamsonTara works out of plastic surgeons’ offices in Raleigh and other locations in North Carolina, as well as in Mississippi and Texas.Restoration Ink/Renee MaschinotRenee provides nipple tattoos in her shop in Fort Lauderdale, FL and travels to plastic surgeons’ offices and hospitals in Jacksonville, FL; Charleston, SC; Hoboken, NJ; Baton Rouge and Lafayette, LA; and Houston, TX.Cariangel/Carrie PatakyCarrie offers nipple tattoos in her facility in Scarsdale, NY and in plastic surgeons’ offices in Westchester County, NY, in New York City, in Connecticut, and in New Jersey.

What to expect during and after nipple tattooing

An appointment for nipple tattooing can take 1 to 2 hours. During the appointment, the tattoo artist will talk with you about your preferences for nipple and areola size, shape, placement, and color.

If you still have one of your natural nipples, the tattoo artist will match the new nipple’s color and size to it. If both your nipples were removed during the mastectomy, you may want to provide the tattoo artist with a pre-surgery photo of your breasts as a reference point. If you don’t have a photo, you can ask your breast or plastic surgeon for one.

To help determine the best positioning for the nipple tattoos, the tattoo artist may place silicone prosthetic nipples on your breasts. The tattoo artist will also review a palette of pigments with you (tones of pink, tan, beige, brown, and purple) to select colors for the nipple and areola that look natural and that complement your skin tone. After mixing the pigment, he or she will temporarily apply a swatch of the color to your breast skin so you can see what it looks like in different lighting and when you move around.

The tattoo artist will also draw markings on your breast to show the location, size, and shape of the new nipple and areola.

The tattooing usually takes about a half hour or so per nipple. Because the reconstructed breast doesn’t have the same sensation as before mastectomy, tattooing the area usually isn’t painful. Still, some women report experiencing some mild discomfort or pain during nipple tattooing.

The nipple tattoos will be covered with a protective dressing. Ask for instructions about how to care for the area. It usually takes about 7 to 10 days for the area to heal. Avoid chlorinated pools, hot tubs, and bathtubs, as well as sun exposure, for several weeks after the tattoo application.

Paying for nipple tattoos

The price for nipple tattoos provided by an experienced tattoo artist is typically about $350 for one nipple and $600 to $800 for two nipples if you’re paying out of pocket. The price may be higher if the tattoo artist is traveling to your area to do tattoos.

Some insurance plans cover nipple tattooing. Medicare often covers nipple tattooing (although it is not required to do so under federal law), and Medicaid coverage can vary from state to state. If you receive your nipple tattoo at a plastic surgeon’s office or hospital (whether from a member of the medical staff or from a visiting tattoo artist), then that facility can usually handle the insurance claim for you.

If you get your tattoo at a tattoo artist’s independent studio, then you’ll have to submit the claim to your insurance yourself. You can submit a receipt from the tattoo artist and a prescription for the tattoo from your plastic surgeon that contains the appropriate insurance codes. The tattoo artist may also write a letter to the insurance company on your behalf. You, your plastic surgeon, and your tattoo artist may need to make the case in writing that the nipple tattoo is a medically necessary part of the breast reconstruction process and not just cosmetic.

If you don’t have insurance coverage and can’t afford to pay full price for a nipple tattoo, some tattoo artists may offer a discount or may have certain days throughout the year when they offer free nipple tattoos. Also, the nonprofit organization Sharsheret provides grants to help cover the cost of nipple tattooing for women in need in New York, New Jersey, Pennsylvania, Florida, Illinois, and California.

Prosthetic nipples and temporary nipple tattoos

Some women find stick-on (prosthetic) nipples to be a surprisingly good alternative to nipple reconstruction surgery or nipple tattooing. You may want to try prosthetic nipples if don’t want 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 and you can put them on and take them off whenever you’d like. They are either self-sticking or come with a special skin adhesive that can hold the nipple in place for several days or longer. They look and feel like real nipples, and are available in different sizes, colors, and projections.

Two of the best-known brands are:

Pink Perfect, which offers readymade silicone prosthetic nipples in a variety of styles and colors and custom-made ones that are designed to match your native nipples. The nipples are attached to the breast using adhesive and can be worn in the shower, ocean, or swimming pool.
Amoena, which sells readymade silicone prosthetic nipples that are self-sticking and available in four colors and three sizes.

Some insurance companies cover the cost of prosthetic nipples. You will in most cases 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.

Another option to explore that has the advantage of being inexpensive: temporary nipple tattoos, such as Rub-on Nipples, Tata Tattoos, and Nipplebacks. These are applied to the skin using a wet cloth, can last 1 or 2 weeks, and can be removed with rubbing alcohol.

Written by: Jen Uscher, contributing writer

This page was developed with contributions from the following experts:

Sophie Bartsich, M.D., FACS, plastic surgeon in private practice in New York, NY, assistant clinical professor of surgery at New York-Presbyterian/Weill Cornell Medical Center

Paul Bessette, tattoo artist with the Vinnie Myers Team in Finksburg, MD, who specializes in 3D nipple and areola tattooing

Constance M. Chen, M.D., MPH, FACS, plastic and reconstructive surgeon in private practice in New York, NY, assistant clinical professor of surgery at New York-Presbyterian/Weill Cornell Medical College

Frank J. DellaCroce, M.D., FACS, plastic surgeon, founding partner of the Center for Restorative Breast Surgery and the St. Charles Surgical Hospital in New Orleans, LA

Ron Israeli, M.D., FACS, plastic surgeon, founding partner of New York Breast Reconstruction and Aesthetic Plastic Surgery in Great Neck, NY, clinical assistant professor at the Zucker School of Medicine at Hofstra/Northwell

Elisabeth Potter, M.D., plastic surgeon in private practice in Austin, TX, affiliate faculty member in the department of surgery and perioperative care at the University of Texas at Austin Dell Medical School

Smita Ramanadham, M.D., FACS, board-certified plastic surgeon at SR Plastic Surgery in East Brunswick, NJ

Mandy Sauler, AAM, tattoo artist, medical tattoo specialist, owner of the Sauler Institute of Tattooing, Philadelphia PA and New York, NY