Without a nipple, a breast is incomplete, and during reconstruction, it should not be an afterthought. At MUSC, we are changing expectations of a finished breast reconstruction by paying special attention to the nipple. Our team includes an esthetician specially trained in 3D tattooing of the nipple and the surrounding ring of pigmented skin (areola). We strive to provide each reconstructed breast with a beautiful nipple and areola.
During nipple reconstruction, your plastic surgeon rearranges the skin on top of the breast mound to form a nipple. Three small flaps of skin, along with the underlying (subcutaneous) fat, are sutured together so the nipple will project out. Any resulting scars, while minimal, are easily concealed with areola tattooing by our specially trained artist. It is not necessary to use tissue from the groin or labia, as some do, but possible if requested.
We may do nipple reconstruction at the same time as symmetry adjustments during Stage 2 reconstruction. Otherwise, the nipple is shaped in a clinic setting with local anesthetic. In order to allow for postoperative swelling to decline and your breasts to settle, you will need to wait three months after Stage 2 breast reconstruction before undergoing nipple reconstruction.
Reconstruction of two nipples takes approximately 30 minutes in a clinic setting. You will be sent home with “nipple protectors” so that your clothes do not flatten your nipple. Reconstructed nipples are very large at first, but over time, this projection will decrease.
The areola tattoo – the finishing touch to breast reconstruction – can be completed in the clinic setting as soon as six weeks after nipple reconstruction. If you have a breast implant and have regained some breast skin sensation, you may need local anesthetic. Most patients with flap reconstruction have little sensation and do not need any anesthetic. During the procedure, you may feel a pushing and vibrating sensation, as many small needles transfer pigment into your skin.
Our nipple tattoo artist is a fully licensed esthetician. In addition, she completed a two-year apprenticeship from which she received advanced training in the paramedical aspect of permanent makeup. She now specializes in 3D nipple and areola tattooing for breast cancer survivors. She will consult with you to make sure that you get the areola color, size, shape and placement that you desire.
If you had both breasts removed during mastectomy, she can use photos taken beforehand to recreate the nipple color, or you can pick a new color that you like against your skin tones. If you are matching a new nipple areola to the existing breast, she will mix various colors and shades to get the correct pigment.
It is harder to match what is natural when one breast has been removed than it is to create two new matching areolas. However, with her superior artistic ability, she can replicate the look of the unaffected breast on the newly constructed breast for unbelievable, natural-looking results.
Because tattoos do fade with time, a touch up may be required later on.
“I sought out Hollings Cancer Center. I’m from Hilton Head. I don’t live in the area, but I really wanted to go to the best place I could find.”
Reach Martha Michaud's story.