Nipple Reconstruction; Is it Painful? What is the Procedure Like?

Nipple reconstruction after a breast reconstruction is a relatively simple procedure that can be done under local freezing.  In some patients who unfortunately have little to no sensation in the mastectomy skin, there is not even the requirement for freezing.

Nipple reconstruction a small procedure but unfortunately the outcomes are difficult to control.  Most annoying problem with nipple reconstructions is the fact that the nipple projection tends to collapse over time.  For this reason the size of the nipple is overcorrected (made very pointy) because we know that it will flatten over time.

You have been through the hardest parts of reconstruction.  The nipple reconstruction should not be painful.  It can be done under local anesthesia but since you are having other procedures done, that might not be appropriate.  I usually tattoo the skin first to give the nipple and areola their color.  You and your surgeon can choose the color for the best match.  Sometimes it is better to use a skin graft for the areola.  The nipple is created by cutting little flaps of skin and stitching them together so they stand up.  The new nipple will shrink so we make it larger to plan for this.  Good luck and congratulations on completing the reconstruction 

Hi Yvonne,

Great news: nipple reconstruction is not painful and you've already been through the more difficult parts of breast reconstruction!

Nipple reconstruction is done through "surgical origami" - your surgeon will rearrange the skin to make a protruding nipple. Before the surgery it is necessary to work out where to place the nipple on the breast, so that symmetry and breast aesthetics are achieved. If you have had reconstruction with a TRAM or DIEP flap then the area of skin that is operated on usually does not feel pain, so you will not feel the usual sting of the local anaesthetic that is used.

Tattooing is performed to achieve a coloured areola and nipple, again aiming for symmetry and ideal aesthetics. A number of different tattoo pigments are used, so that the colouring looks natural, and the edge of the areola is blurred (like a natural areola - which is a blurry line, not one drawn on with a pencil or texta).

Sometimes a skin graft is used in nipple reconstruction. If this is the technique that your surgeon uses then an another small area of skin (for example, your abdomen or groin) will also be numbed with local anaesthetic for the procedure. After the skin graft is taken this area is stitched closed and a waterproof dressing applied to the area.

As there are variations in the types of nipple reconstructions performed by different surgeons I recommend that you ask your surgeon to explain his or her technique, as it may differ slightly from what has been described on this page.

Good luck!