After implant reconstruction or autologous reconstruction, you can decide if you'd like to have your nipple reconstructed, too. Some women do and some don't -- the choice is up to you. You have time to make that decision. Nipple reconstruction is done after the reconstructed breast has had time to heal -- at least 3 or 4 months after reconstruction surgery. But you can take longer to decide if you'd like. You can have the nipple rebuilt and then tattooed with color if you wish, or you can have a three-dimensional tattoo that looks like a nipple, although really it’s flat.
Here is a breakdown of your options if you decide to have nipple reconstruction:
Nipple reconstruction using tissue. The nipple may be reconstructed from the surrounding skin at the site desired for nipple placement. The surgeon makes small incisions and then elevates the tissue into position, forming and shaping it into a living tissue projection that mimics the natural nipple. Older techniques, which used donor tissue from the genital region or elsewhere, have become less favored over time.
The new nipple can then be tattooed to add color and create the areola around the nipple. Three-dimensional color shading of a fleshy nipple tends to produce a result with both visual and physical depth. Most medical aestheticians in plastic surgeons’ offices use the dermabrasion technique, which uses a high-frequency vibrating probe to push pigment into the skin. To achieve full color, several sessions may be needed. The range of colors available for dermabrasion may be limited and dermabrasion tattoos tend to fade over time.
A nipple tattoo. Instead of using tissue to rebuild a nipple, some women choose to have a nipple tattooed on the reconstructed breast. Some women decide to have a star, a heart, or another meaningful image tattooed on the reconstructed breast instead of a nipple.
The most realistic results are often achieved with 3-D nipple tattoos, which are basically real tattoos that use oscillating needles coated with pigment. The needles insert the pigment into the skin. This approach essentially creates a “picture” of a nipple and has no physical dimension, but it can look quite real—although it does tend to look better from a distance than very close up. A tattoo artist can use a wide range of colors and one session is usually all that’s needed, although it may require touchup sessions over time. 3-D tattoos are permanent and usually don’t fade. 3-D nipple tattooing can be used to create new nipples and to color-correct previous nipple tattoos that have faded or have undesirable colors.
Vinnie Myers, a tattoo artist and former Army medic, is one of the few people we at Breastcancer.org know of who specialize in 3-D nipple tattoos. Since 2002, Myers has immersed himself in the art of 3-D nipple tattoos. He works with the Center for Restorative Breast Surgery in New Orleans. Myers also travels extensively to work with as many women as possible. To learn more about his 3-D nipple tattooing, read Myers’ blog posts.
The Whitney Center for Permanent Cosmetics also offers 3-D nipple tattoos, with locations in New York City; Montclair, New Jersey; and Boca Raton, Florida. Owner and founder Melany Whitney has a number of credentials, including being a board-certified permanent makeup artist and instructor and a fellow of the American Academy of Micropigmentation. She is professionally associated with physicians at many U.S. hospitals including New York Presbyterian Weill Cornell Medical College and the Dubin Breast Center at the Tisch Cancer Institute at Sinai Hospital, both in New York City.
In either case, areolocation – the precise positioning of the new nipple and areola (the colored skin around the nipple) using a high-resolution laser technique – can help ensure the best placement of the new nipple and areola. Latex nipples are placed for accurate color and size and then the nipples are tattooed.
Right now, areolocation is available at a limited number of facilities, including Lankenau Medical Center in Wynnewood, Penn. Breastcancer.org Chief Medical Officer Marisa Weiss, M.D. is heading a movement to bring the technique to more hospitals around the country.
Because the reconstructed breast doesn't have the same sensation as before surgery, tattooing the area usually isn't painful.
If you don't want to have another surgery, but do want a nipple, there are several “fake nipple” options. Perhaps the most common are removable polyurethane nipples, which are in a semi-erect position and are very close to a natural nipple's texture and color. To attach the nipples, you moisten the back and stick them on -- like a little suction cup. You can put them on and take them off as you'd like.
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