Does the nipple get cut off during a mastectomy if it dies?

I woke up from surgery and one nipple was black on the end after a nipple sparing mastectomy. No one knew why but there was a film over it. How does it bleed if there is no blood flow?

Doctor Answers 4

Nipple necrosis

I am so sorry to hear of your post mastectomy nipple issue. If the blood supply is compromised the nipple may completely die  or only a portion may necrose. If the nipple is not completely dead, but ischemic (lacking adequate blood supply), it may be salvageable. Applying blood vessel dilating creams and antibiotics, keeping the breast warm and time may improve things. Hyperbaric oxygen is controversial, but may improve blood supply to a compromised nipple which is not completely dead. If the nipple is partially dead, that tissue must be removed to prevent infection, but if part of the nipple is viable (alive) it should be preserved and watched carefully. It may be preserved. IF the nipple dies and cannot be saved, it must be removed. Once the wound heals, an new nipple can be reconstructed using adjacent skin to make it 3 dimensional then tattooed an appropriate color. Some tattoo artists are so good that the tattoo alone looks 3 dimensional and very natural.

Nipple necrosis after nipple sparing mastectomies

Sometimes a portion of the nipple can "die" after a nipple sparing mastectomy. I often wait 1-2 weeks to take someone back to the operating room to remove this dead portion of nipple, as sometimes the area looks worse than it is. On the flip side it's not good to leave the non-viable portion of skin/nipple in place too long as it may predispose you to infection. If it is only a portion of the areaola that is dead that can be tattooed or skin grafted later. If the nipple itself has a necrotic portion I would wait to see how much remains after everything is healed and consider some type of reconstruction of the nipple such as fat grafting or enhancement with a 3D tattoo. 

Tracy Kayan, MD
Minneapolis Plastic Surgeon
5.0 out of 5 stars 9 reviews

Nipple loss

Sometimes the nipple dies from the very thin skin flaps that are left after a mastectomy. Sometimes it is only partial loss and treatment is conservative with local wound care. Other times the skin and nipple that clearly necrose are cut out and then reconstructed at a later date.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Thanks for your question.

Sorry to learn of your healing difficulties. It is best to discuss your concerns with your plastic surgeon. In general, the outcome from breast reconstruction depends on many factors not the lead of which is the blood supply to the breast skin, including the nipple, upon completion of the mastectomy. Your plastic surgeon and breast surgeon together decide on the best course of action during surgery after the mastectomy is complete, but sometimes there are indeed healing complications. As a rule, if the blood supply is insufficient, the area of skin or underlying tissue will go on to heal poorly and either require surgical removal ("debridement"), or will heal over time with good wound healing. 

It is best to follow up with your surgeon. If you feel that a second opinion is required, please consult with a board certified plastic surgeon experienced in breast reconstruction. Best of luck to you. 

Ram Kalus, MD
Mount Pleasant Plastic Surgeon
4.8 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.