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.
Your surgeon or a nurse 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 can be taken from the newly created breast, the opposite nipple, your ear, eyelid, groin, upper inner thigh, or buttocks. 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: A small incision is made at the donor site and a small amount of tissue is removed and formed into a nipple shape. All the hair follicles should be surgically removed from the skin before it's shaped into a nipple. A small incision is also made in the reconstructed breast so the new nipple can be attached. If the skin from the donor site doesn't exactly match the color of your other nipple and areola, the area can be tattooed the right color later, about 3 months after surgery.
If the new nipple is being formed from skin on the reconstructed breast, the surgeon makes a small incision and bunches or twists the skin into a nipple shape and then stitches it into place.
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.
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.