Before nipple reconstruction surgery: Nipple reconstruction surgery is usually done as outpatient surgery, which means that you don't stay overnight in the hospital. Your doctor will give you a list of instructions on how to prepare for nipple reconstruction surgery. You'll probably be told not to eat or drink anything and there will be medications that you shouldn't take before the surgery. You also will need to make arrangements for someone to drive you home. Per federal law, it should be covered as part of your reconstruction. (See Paying for Reconstruction Procedures.)
Your surgeon will draw markings on your breast (and donor site if skin from another area of your body is being used) to show where the incisions will be made. Usually this is done with a felt-tip marker. You’ll probably be standing up while this happens.
Nipple reconstruction is often done under local anesthetic. This means that your doctor will use a needle to inject numbing medication into the area where the reconstructed nipple will be. If you have local anesthetic, you will be awake during the procedure.
Skin to create the new nipple is usually taken right from the site where the new nipple will be located. This has become the favored approach. However, some surgeons still do take skin from the inner thigh or labia (skin folds around the vagina) and graft it onto the breast to form a nipple. Another potential source is the opposite breast. Make sure you’re clear about how the reconstruction is being done and why, especially if a graft is recommended. If your doctor is taking skin from another place on your body to reconstruct the nipple, that area will be numbed with local anesthetic as well. Only a small amount of skin is needed to recreate the nipple.
If you and your doctor decide that nipple reconstruction surgery should be done under general anesthesia, an intravenous infusion (IV) line will be inserted into your hand or arm and taped into place. You'll be given relaxing medication through the IV line.
During nipple reconstruction surgery: Typically, a small incision is made at the site where the nipple will be made. The skin is formed into a nipple shape and small sutures (stitches) are used to secure the form. The new nipple and surrounding areola can be tattooed about 3 months after surgery.
If your surgeon plans to use grafted skin as part of the nipple reconstruction, there will be an incision in the area from which the skin was taken. Again, be sure to clarify whether this will be necessary or not, and if so, why. Grafted nipple reconstructions can sometimes have a “stamped on” appearance where the edge of the reconstructed areola meets the surrounding breast skin.
Some surgeons insert a core of dermal matrix product – a skin substitute such as AlloDerm -- into the reconstructed nipple so it doesn't flatten out too much. However, most surgeons will use a small amount of your own scar tissue or fat to accomplish the same goal.
Once the nipple is sewn into place, a nipple shield (a protective covering shaped like a tiny hat with a wide flat brim) is filled with antibacterial ointment and taped over the reconstructed nipple to protect it.
The length of nipple reconstruction surgery can range from 30 minutes to an hour or so. Tattooing, which happens about 3 months after the nipple reconstruction surgery, usually takes 30 to 40 minutes.
After nipple reconstruction surgery: If you've had local anesthesia, you'll be able to go home after the nipple shield is in place. If you've had general anesthesia, you'll be moved to a recovery room after surgery, where hospital staff members will monitor you. Once you're awake and your doctor has checked your heart rate, body temperature, and blood pressure, you'll be allowed to go home. No matter which type of anesthesia you have, make sure you arrange for someone else to drive you home.
Your doctor will give you specific instructions to follow for your recovery. For detailed information on how to care for dressings and stitches, visit the Mastectomy: What to Expect page.
The nipple shield is usually left on for about 3 days. After it's removed you can shower. Your reconstructed nipple will probably look pointed and somewhat larger than your other nipple. After the stitches are removed -- usually after 2 weeks -- the nipple will begin to flatten out and look more like your other nipple.
The reconstructed nipple can be tender for a week or so. Ask your doctor for medicines you can take to ease any pain you may have.