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!

The nipple reconstruction should not be painful. The fat grafting will probably bother you more than the nipple reconstruction.

Nipple reconstruction is typically not a painful procedure. Usually the nipple is created from the skin of the breast. This skin is often still numb at the time of reconstruction. In our office, this is performed under local anesthesia and takes anywhere from 15 to 30 minutes. Once the nipple is created and healed, the nipple is then tattooed in a separate procedure which creates the areola as well. Some surgeons prefer to use a skin graft to create a textured areola, although this is not always necessary. There are several ways to create a nipple and even ways to borrow the nipple from the other non-cancer breast. Your surgeon will be able to explain this procedure to you and likely have photos for you to see what the results look like.

Nipple reconstruction is usually not too uncomfortable. If you had a TRAM or free flap, then you probably will not even feel it because the tissue is insensate.  

Nipple reconstruction is often done in the office under local anesthesia and is the least "difficult" of all breast reconstruction procedures for the patient. Nipple reconstruction is done by re-arranging the local skin around the breast to form the part of the nipple that projects, there are various way to do it, but they all use the same principle; re-arranging local tissue. The pigmented portion of the areola is most often done by tattooing at a later date. Good luck, almost there!

Nipple reconstruction is not painful and can often be performed as an outpatient procedure under local anesthesia.  There are a number of ways of making a natural appearing nipple/areola.   For the best color match, I have patient choose tattoo pigments from a color chart.  Often, we will pick two or three colors that match the opposite nipple/areola.  The tattooing is done in a way that the color is variegated so that it matches and follows ones own natural color tones.  The nipple is then made from small local flaps of skin and fat on the breast mound.  The patient is an integral part of the decision making process and I usually have them choose the size of the areola and the position of their new nipples.