Nipple and Areola Reconstruction

There are so many decisions to be made during and after breast cancer. It may seem like the choice of reconstruction, and especially nipple and areola construction is low on the totem pole, at least relative to breast cancer treatments which can save your life, but these reconstructive therapies are one way of restoring your life. They are, at least, a way of feeling as good as possible after treatment.

Doctor in operation room holding a scalpel
Knape / E+ / Getty Images 


The first choice with reconstruction begins with your choice of surgery; whether you have a ​lumpectomy or mastectomy, whether you have immediate or delayed reconstruction, or opt for no reconstruction at all.

Depending on the location of your cancer, you might be a candidate for a nipple-sparing mastectomy. This procedure is becoming more common and tends to have a high satisfaction rate, with women who have this approach reporting a better quality of life. Not all surgeons perform or are comfortable with this approach, and you may need to consider a second opinion at a larger cancer center if this is something you wish to consider.

If you do not have a nipple-sparing mastectomy, the final decision involves choosing to have nipple and areola reconstruction.

Pros and Cons

As with many of the choices you have made with your breast cancer, there are several pros and cons to consider in choosing to have nipple and areola reconstruction. There is not a right and wrong decision to be made, only the decision that is right for you personally.

The Pros

The advantages of nipple and areola reconstruction are basically that the appearance of your breast is as close as possible to the appearance prior to your diagnosis of breast cancer.

The Cons

There are also disadvantages of undergoing nipple reconstruction. These may include

  • The simple fact that this reconstruction is yet one more surgical procedure. This carries the risks of general anesthesia, additional recovery time, and potentially, additional scars (at the site of the new areola/nipple, and the donor site if grafting is used.)
  • Nipple reconstruction may prolong the process of "getting on with your life."
  • A "con" that is not often mentioned, but is not uncommon, is that some women find it more uncomfortable to go braless after a nipple and areola reconstruction than if they did not have the reconstruction. In a well-done breast reconstruction, many women enjoy not having to wear a bra, and nipple reconstruction may interfere with that freedom (or they may resort to using band-aids and tape to cover their new nipples.) Unlike "natural" nipples, reconstructed nipples have one position and do not retract. Some women are embarrassed by the persistent elevation of a reconstructed nipple which may cause them to look "aroused," or at least cold.

Surgical Timeline

Typically, nipple and areola reconstruction is performed at about three to six months after the primary reconstruction. This allows for optimal healing and the dissipation of post-op swelling. However, the timing can vary considerably based on surgeon and patient preference, as well as the specific techniques used in both procedures. 

Reconstruction Techniques

The first step in reconstruction involves either using a skin graft or flap to reconstruct the nipple mound. This is followed by "tattooing" when the reconstructed nipple has healed. Sometimes, tattooing alone is used to create the appearance of a nipple but without further surgery.

Graft Reconstruction

The graft technique for nipple and areola reconstruction involves harvesting skin from a donor site separate from the reconstructed breast. The skin graft is then attached to the site of the newly constructed nipple and/or areola.

Common donor sites for areola grafts include the abdominal scar from a flap reconstruction, the inner thigh, or the buttock crease. For nipple grafts, the three most common donor sites are the patient’s remaining nipple, the earlobe, and the labia. In general, the patient's remaining nipple is the preferred donor site, since it provides the best match in terms of skin texture and color. However, in the case of a bilateral mastectomy (or particularly small nipples), the other donor sites can be quite useful.

Flap Reconstruction

In the flap technique to nipple reconstruction, the nipple mound is created from a “flap” of skin taken directly from the skin adjacent to the site of the newly reconstructed nipple. This technique has the advantage of keeping the blood supply intact, and of confining any scarring to the area of the new nipple and areola (as opposed to creating a new scar at the donor site, as with a graft procedure). The flap procedure is somewhat more reliable than the grafting procedure.

Reconstruction Via Micropigmentation (Tattooing)

The tattooing procedure, called micropigmentation, is usually performed as the final stage of complete breast reconstruction, only after the nipple itself has been reconstructed. This procedure is performed with equipment that is very similar to what one might find in use at a tattoo shop. Its main advantage is that it is a relatively quick and simple outpatient procedure which requires no more than local anesthesia, and does not create an additional scar. In fact, micropigmentation can be used to camouflage the color and even soften the texture of existing scars left behind after the initial breast reconstruction procedure.

Primarily, this technique is used to simulate the color, shape, and texture of the area surrounding the nipple (called the areola). However, for those patients who do not wish to undergo further surgery after their primary breast reconstruction, the appearance of the nipple itself may be re-created using only tattooing. The obvious disadvantage of this method is that it can only create the optical illusion of texture and dimension, offering no nipple projection, but a 2016 study found that loss of projection of the nipple did not decrease satisfaction among women who had this technique. This is also the safest technique.

In some cases, your surgeon may recommend the use of such fillers like Radiesse or Alloderm in order to enhance nipple projection. In this case, it may also be helpful to look specifically for a surgeon or micropigmentation technician who specializes in creating the most realistic-looking and three-dimensional appearance.

Your surgeon or technician will mix various pigments to come up with just the right color to complement your skin tones and/or to match your remaining nipple. Achieving the perfect shades may require more than one visit, and as with any tattoo, the pigment will fade in time, necessitating a return visit for a color touch-up.

Risks and Complications

First, there is the possibility that the graft or flap may not survive in its new location. If this happens, further surgery will be necessary. In addition, if general anesthesia is required, there are the usual risks that go along with it, together with the risks and possible complications inherent to most surgical procedures, which include: unfavorable scarring, excessive bleeding or hematoma, skin loss (tissue death), blood clots, fat clots, skin discoloration or irregular pigmentation, anesthesia risks, persistent edema (swelling), asymmetry, changes in skin sensation, persistent pain, damage to deeper structures such as nerves, blood vessels, muscles, lungs, and abdominal organs, deep vein thrombosis, cardiac and pulmonary complications, unsatisfactory aesthetic results, and the need for additional surgery.

For those who have radiation therapy prior to reconstruction, the risk of side effects (nipple necrosis) is higher, and it's important to talk to your heatlhcare provider carefully if you are considering or if you have had radiation therapy.

After surgery, call your surgeon immediately if any of the following occur: chest pain, shortness of breath, unusual heartbeats, excessive bleeding.


In most cases, reconstruction of the nipple and areola are considered to be the final step in post-mastectomy breast reconstruction. Therefore, by law, the costs would be covered by a woman's insurance. However, you should always check with your insurance provider regarding the particulars of your coverage before scheduling any surgery. Some insurance plans dictate where you can go for surgery as well as specific types of procedures that are covered.

Post-Op Care

Following the procedure, a non-adherent gauze dressing and a generous amount of ointment will be placed onto your breast and held in place by surgical tape. The dressing will need to be changed every few hours for the first few days. If you have been tattooed as a part of your reconstruction, your tattoo will probably ooze a mixture of ink and blood. It is important not to let the tattoo get dry, or to allow excessive friction between clothing and the tattoo during this time.

Because of the blood, the tattoo’s color will appear much darker than it will be once it has healed. During the healing period, scabs will form and fall off, revealing the true color of the tattoo. Do not pick at the scab or try to remove it. If removed too early, the scab will take much of the tattooed pigment with it.

Recovery and Downtime

Reconstruction of the nipple and areola is usually an outpatient procedure requiring less than an hour to complete. Most patients will have some mild pain or discomfort which may be treated with mild pain-killers and will be able to return to their normal activities within a few days.

As with all surgical procedures, it is important to understand that these guidelines can vary widely based on the patient’s personal health, the techniques used, and other variable factors surrounding the surgery. Regardless, it is important to take care not to subject the procedure sites to excessive force, abrasion, or motion during the healing period. Any severe pain should be reported to your healthcare provider.

Scarring and Sensation

If the reconstruction is accomplished by tattooing alone, there is no new scarring created. In the case of a flap reconstruction, the small scars are usually within the region of the nipple and are mostly hidden by the areola reconstruction. If a grafting technique is used, a new scar will show up around the perimeter of the new areola. An additional scar is also created in the donor site.

Regardless of the method used for reconstruction, it is important to be prepared for the fact that the new nipple area will not have the same sensation as the nipple of the remaining breast (or the previous natural breasts).

A Word from Verywell

The choice of whether to have nipple reconstruction or not is completely up to you and there is not a right or wrong way. If you feel that you are simply done with surgery, or don't want to be bothered by further treatments (or nipples that don't retract) don't feel like you have to follow through on these "last steps" of reconstruction. And if you really want to have reconstruction and friends or family are second-guessing you, go ahead and do what works best for you alone.

As you think of your journey with breast cancer thus far, you may feel a bit overwhelmed and tired. It may be some minor consolation to realize that cancer changes people in good ways in well. Studies looking at "posttraumatic growth" in people with cancer have found that cancer survivors not only have a greater appreciation of life but tend to be more compassionate towards others.

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