Nipple reconstruction and nipple tattoos

This page was reviewed under our medical and editorial policy by

Daniel Liu, MD, Plastic and Reconstructive Surgeon

This page was reviewed on February 8, 2022.

If you’ve undergone a mastectomy, you may decide to also have breast reconstruction surgery. In most cases, when the breast is removed, the nipple and the darkened area around it—the areola—are removed as well.

Breast reconstruction creates new breasts in place of what was removed, and not everyone will elect to have the nipple reconstruction procedure that comes later. If you choose to, you have several options when it comes to reconstructing your nipple. Surgery to create a new nipple or nipples may be an option, but it's not the only one you have. You can also decide to have nipple tattooing or use prosthetic nipples.

You have some time to decide how and if you want to reconstruct your nipple and areola. Nipple reconstruction or tattooing is typically done three to four months after reconstruction surgery, so that the breast has enough time to set in place and heal. If you decide to do both, similar healing time is also needed after nipple reconstruction before tattooing is done.

Learn more about what options are available when it comes to nipple and areola reconstruction and nipple tattoos, and factors to consider when weighing each option.

Nipple reconstruction surgery

If you choose this option, nipple reconstruction surgery is the final step in the breast reconstruction process.

Different techniques are available to obtain the necessary nipple tissue for this surgery.

  • Skin flap reconstruction: Most of the time, a surgeon will use the skin of the reconstructed breast to form a nipple shape and stitch it closed.
  • Skin graft reconstruction: Sometimes a surgeon may use a skin graft, where tissue from another part of your body, such as your inner thigh, is taken to form the nipple.

What to consider

Your surgeon's goal is to be able to match this new nipple to your other one, or match both nipples to each other if you had both breasts reconstructed. The position, shape, size and projection—or how much they stick out—are all taken into consideration. You have a part in this conversation and process as well. You’ll share all of the decisions with your care team.

Nipple reconstruction surgery can make the area resemble a natural nipple, but it won’t necessarily give the nipple a natural color. If you want the nipple to have a color similar to a natural breast, or to have both nipples match, tattooing is an option after surgery. This is an additional procedure that can be done several months after the nipple is reconstructed.

How to prepare

Nipple reconstruction is usually an outpatient procedure. Because of this, you may not need to do a lot to prepare. Your care team may ask you to stop taking certain medications ahead of the procedure and to stop eating and drinking at a given time the previous night. Make sure to get your questions answered by your provider so you feel as comfortable as possible.

Recovery from nipple reconstruction surgery

Your care team will tell you how to care for yourself after nipple reconstruction surgery and provide specific instructions. It’s normal to have some swelling and bruising right after surgery.

  • You’ll be given nipple protectors to cover the incisions for up to two weeks. You can shower, and your breast area can get a bit wet, but try to keep water from directly hitting it and possibly shifting the nipple protectors. You should avoid bathing in a tub or pool until your care team says that’s OK.
  • If a bra is comfortable and fits with your nipple protectors, you can wear it. Or, you can wear a special post-surgical bra.
  • A week or two after surgery, you’ll likely have a follow-up appointment in which your care team will check on your healing.
  • You can resume most normal activities when you get home after surgery, but avoid doing anything that makes you sweat or any heavy lifting until after your follow-up appointment.
  • Take pain medication as your care team prescribed it, and keep up with your fluids. Some pain medications can cause constipation, and drinking water can help avoid stomach issues.

Call your doctor right away if:

  • Your pain worsens.
  • The nipple protectors are irritating your skin and you see redness or discharge.
  • You have a fever, nausea, vomiting, shortness of breath or leg pain.

Risks of nipple reconstruction surgery

Nipple reconstruction is typically an outpatient procedure with few risks.

But, with any reconstruction surgery, infection is always a risk, so make sure you understand your post-surgical instructions and call your doctor if you notice anything concerning in the area, like pus, a bad smell, or if you have chills or fever. One October 2013 study in the European Journal of Plastic Surgery points to nipple reconstruction being a high-risk procedure for people who have had radiation therapy.

Complications from nipple reconstruction surgery

Complications from nipple reconstruction surgery, though rare, may include:

  • Flattening of the nipple
  • Wound reopening
  • Infection
  • Injury to the tissue involved

3D nipple tattoos

No, nipple tattoos aren’t actually three-dimensional, but they look like they are. If you don't want to, or are unable to, have another surgery, another option may be nipple tattoos. This can be performed by a plastic surgeon skilled in tattooing, or it can be done by another professional, even a licensed tattoo artist experienced in nipple tattoos. Using shades of pigment, these flat tattoos can be created to look three-dimensional.

What to consider

You have the option to have tattooing of the areola, the nipple or both. You can work with the professional doing the tattooing on how you want the pigmented color to look. Nipple tattoos can be a good option if you don’t want to have another surgery. Likewise, tattooing won’t leave scars, and has a much faster recovery period than that of reconstruction surgery. You can work with your tattoo artist on the specific look you want.

However, not every woman is a candidate for tattooing. Sometimes damage or thinning to the skin from radiation or surgery can change the way your tissue handles tattooing. It may also trigger inflammation and infection in some patients. All of these factors will be taken into consideration when you, your care team and tattoo expert decide on how the tattoo process could work for you. 

How to prepare for a 3D nipple tattoo

Having a 3D nipple procedure is similar to having a tattoo anywhere else on your body, so there may be some discomfort during the procedure itself. You won't usually need to do anything special to prepare for this procedure.

Risks of nipple tattoos 

Infection at the site could happen, so make sure you're following care instructions for the tattooed area at home, such as washing the area with soap and water and applying an antibacterial ointment.

Prosthetic nipples

The least invasive of nipple options is prosthetic nipples—it doesn’t require additional surgery or tattoo needles. Nipple prosthetics can give you the appearance of nipples, but they’re removable. Nipple prosthetics are made of silicone or other materials, so they look and feel close to the real thing. These prosthetics can be positioned and attached to the breast, and you can take them off whenever you'd like.

What to consider

Nipple prosthetics are a great option if you're still trying to make a permanent decision about your nipples. You can use them and take them off whenever you want.

How to prepare for prosthetic nipples

Check with your insurance to see if they will cover nipple prosthetics. You may also need to do some research to find reputable companies that sell these prosthetics.

Risks of prosthetic nipples

Nipple prosthetics need to be cared for according to their directions, and you’ll need to inspect the site periodically to make sure your skin isn’t irritated by the prosthetic.

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