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.
If you don't want to have another surgery, but do want a nipple, you can buy removable polyurethane nipples. These nipples 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.
If you do decide to have nipple reconstruction, you have options:
- Nipple reconstruction using tissue from another part of your body. A reconstructed nipple doesn't have the same sensation your original nipple did before reconstruction surgery. The new nipple and areola (the dark area around the nipple) can be tattooed to match the color of the nipple on your other breast. Tissue to rebuild the nipple is usually taken from your chest wall or your upper inner thigh.
- Nipple reconstruction using a dermal matrix product (a skin substitute made mostly of collagen -- AlloDerm, Strattice, NeoForm, and DermaMatrix are examples)
- 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.
There are two types of nipple tattoos: dermabrasion and 3-D tattooing:
- Dermabrasion nipple tattoos use a high frequency vibrating probe to push pigment into the skin. Most medical aestheticians in plastic surgeons’ offices use the dermabrasion technique. 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.
- 3-D nipple tattoos are basically real tattoos that use oscillating needles coated with pigment. The needles insert the pigment into the skin. A tattoo artist can use a wide range of colors and one session is usually all that’s needed. 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 Johns Hopkins Hospital in Baltimore, the Center for Restorative Breast Surgery in New Orleans, Lankenau Medical Center in Wynnewood, Penn., Capital Area Plastic Surgery in Saratoga Springs, NY, and Microsurgical Breast Reconstruction in Charleston, SC. Myers also travels extensively to work with as many women as possible. To learn more about his 3-D nipple tattooing, read Myers’s 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 Founder and President 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.
Learn more about nipple reconstruction on these pages: