Nipple reconstruction

Mastectomy usually means removal of the whole breast including the nipple and areola (the coloured area of skin around the nipple), but it is possible to have the nipple reconstructed. Nipple reconstruction is usually done a few months after the breast reconstruction to give the new breast time to settle into its final shape and position.

Skin can be taken from the areola around the other nipple or the top of the inner thigh, since these areas tend to be darker than skin on the rest of the body. Sometimes part of the other nipple can be used as a graft. A nipple can also be reconstructed using an area of skin and tissue which is later tattooed to match the colour of the other nipple and areola. More medical information about nipple reconstruction is available from Macmillan Cancer Support.

Many women who’d had breast reconstruction were waiting to have surgery to match the healthy breast with the reconstructed one (mastopexy). Several were also planning to have nipple reconstruction at this time too, though were unsure about what this would involve.

Patricia feels she would have recovered quicker if shed had an immediate breast reconstruction…

Age at interview 54

Gender Female

Age at diagnosis 53

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When you looked at it, were you happy? You mentioned that you might have a nipple put on later.

Yes, I’m going to have a mastopexy, when they lift the other one, because obviously having been a mum and breast fed, one’s a lot lower than the other, so she’s going to lift that and then she’s going to give me a nipple to match, and then we have the area tattooed to make it look as even as possible.

And how have you felt emotionally in terms of having the reconstruction, having the mastectomy first?

It would have been nice to have had the reconstruction straightaway. I’m sure I would’ve recovered emotionally perhaps a lot quicker if I’d had the reconstruction first, but if I’d had to have radiotherapy and then had to, you know, it’d had all hardened, in the end it would have just been one more ordeal. Most of the time I’m pretty resolved about everything that I’ve gone through. You just, you know, it’s happened, there’s nothing I can do to change it, so just get on with it.

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Hilary is planning to have her healthy breast reduced and nipple reconstruction using tissue from…

Age at interview 67

Gender Female

Age at diagnosis 66

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I saw [the plastic surgeon] on the 31st of January and said, Oh I don’t need to see you now for another six months Where I’m going to have, what do I call it to the girls? Oh my boob done on my left one. Which again I was quite surprised because when [the plastic surgeon] first saw me he said, Oh we’ll do your left as well And I thought, Ooh I just thought they’d take this one off and that would be it.

But no, quite concerned that yes they would match me up. And if I wanted it increased, well not increased but decreased, I could if I wanted. But no, I said no because I went in a 38DD. We all laugh about it now because I’m a DD this side and an E this or I think it’s a C this side or something [laughs]. So no that’s everything really. So I go back in July, July the 31st now to see [the plastic surgeon] about all the other things I’ve got to have done. Which I’m not really, no I can’t say that I’m worried about it, you know, because of, as I say, my first experience of being fine.

I’m going to have a new nipple put on as well. So, as I said, again, because I was told, I wasn’t left, I felt quite at ease with it, you know.

Yeah. And you’ve discussed with him that you’re going back, are you, to have the other breast matched with that one?

Yeah.

Yeah. And when they did the surgery, did they ask you then about matching the other one?

Yes. I, yes before, well before the surgery. My very first visit I saw [the plastic surgeon], he discussed that.

Yeah, so you knew then

Yeah. That was my choice. I needn’t have it done if I don’t want to. But, as I say, I’m going back to see him the 31st July where we will discuss all this then.

Yeah. And then you’ll probably go into hospital again for a short time to have it matched.

To have that done, yeah.

And when would they be able to put the nipple, it’s a tattoo, isn’t it, a nipple?

That’s, well the actual nipple they’re going to put an actual nipple on. Again, I had a choice of that. I could have had the stick on ones or whatever. But I said, Oh no, I would have that So.

So, how do they, it’s an actual nipple is it?

Yes, I think what they do is take something from the inside of your leg and sort of make the nipple. And then, as you said, they do tattoo the aura is it, yeah around. They do that. That was all explained to me well before surgery.

Yeah. And did they say how long afterwards you would have the nipple put on?

No, he just said he’d see me again in six months and I presume then if everything’s OK you know, he’ll say when he can do it, when he’ll be able to do it. I must admit we’ve not really sort of gone down that lane yet. You know. So, as I said, he did say when I saw him in January that he would put right the bit of a scar that I’ve got. Whether that was due to the fullness of my breast, I don’t know. That’s something that I will ask him and no doubt he’ll tell me.

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Sandra is happier with her new breast now and plans to have her healthy breast lifted and nipple…

Age at interview 51

Gender Female

Age at diagnosis 50

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My implant, I’m not noticing it now. Also the swelling is at last really, really settling and it’s looking much more like my right breast. My right breast is obviously lower, but the plastic surgeon has said he will re-arrange the furniture cos I said I didn’t want an implant or anything in my right breast, but he said, No, no, no, you don’t need that He said, We’ll re-arrange the furniture, we take out tissue from the bottom, put it in the top and just shift the nipple up and he said they do that at the same time as having a reconstruction of the nipple cos I have no nipple on the left breast. So I’m up, okay. And whether I’ve got used to it, whether because all the swelling has gone down, it definitely looks better. I now, when I catch sight of myself in the mirror, I’m not having a double take now.

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One woman, who’d had a DIEP flap reconstruction two years after a mastectomy, said she was happy with her new breast and had a nipple reconstructed using her own tissue. Another had nipple reconstruction after an immediate DIEP flap reconstruction. Both said their first nipple reconstruction had failed. One had had another nipple reconstructed shortly afterwards, which had succeeded, and the other was planning to have a second nipple reconstruction. Both were pleased with how their new breast looked.

Hilary was pleased with her breast reconstruction but even happier after having nipple…

Age at interview 57

Gender Female

Age at diagnosis 50

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I had my second part of the reconstruction, I mean that the other breast was reduced I’m still quite big. I’m about a 38, 40 D now as opposed to 40DD, F at times. So I have come down quite a lot. But then, you know you could’ve gone down to a nice 36 something. But then, is that me? And I had wondered about that a few times.

nd then I had a new nipple put on, created out of my own sort of tissue there. And that was done by another surgeon. It didn’t work. After about six months it disappeared. So my original surgeon said he’d do it. And it succeeded. And I’ve had that sorted too.

And in terms of the scars and everything, did you feel happy with the result?

Thrilled [laughs]. Absolutely thrilled. Yes.

And felt comfortable looking at yourself in the mirror, no concerns or

No I feel happier now I’ve had the nipple done. I wasn’t that unhappy before. But it just balances it and, you know, with clothes and that. When you’ve only got one nipple, it’s not often that your nipples sort of show. But when they do, you want them both to show or neither sort of thing [laughs]. Just having one is a bit strange. And I love swimming. And it made a huge difference going swimming. Because when I had the prosthesis I was virtually hiding in the cupboards. And I know there’s no need to. But I didn’t, I felt not awkward for myself as much as awkward for other people’s reactions to it

Yeah. And did you feel sensation come back as before or different?

Well. Yes it’s different. it’s not as sensitive as before. It doesn’t behave sort of, the nipple hasn’t got any sensation at all. The breast feels very similar to what it did before, a slight change in density. But it’s very soft because it was stomach tissue, that’s better than the back tissue.

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Both Beverley and her husband were pleased with her breast reconstruction. She can wear low cut…

Age at interview 52

Gender Female

Age at diagnosis 50

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How long did it take for you to feel, I’m really happy with thi? Because you mentioned it’s brilliant.

Yes, yeah. No, I was happy with it right from the beginning really. It’s just so much better than having nothing there at all. And because they have to check it so often I looked at it immediately. And I know my husband was really, really reluctant to look. He was really worried over what he was going to see. And he came to see me, hmm, a couple of hours of coming down back from the theatre and she came to check it. And I said to him, Come and look And he said, No, no. I won’t now And I said, You come and you look And he came and looked and even he went, Wow, it’s brilliant [laughs] Because I think he wondered what he was going to see. But no, he said, No, it’s brillian. They have done a brilliant job.

Yeah. And how does it compare with the other one?

It’s, I haven’t, well didn’t have a nipple. They’ve reconstructed one and they’re actually going to try and do a better one in a few weeks time. And they tattoo it. So you can, so it can look very similar. But it doesn’t, it won’t feel the same. You don’t have the feeling in there but I’ve become, I’m always wearing low tops now and I never used to before. But all of a sudden I’ve become very proud of these boobs that I’ve got. I think I didn’t, took them for granted before. But all of a sudden I’m very proud of them and I flash them around all over the place, but [laughs]

And you mentioned there’s no nipple at the moment but they’re reconstructing

I did, they did reconstruct the nipple for me but it’s flat, flattened out, using part of the tummy skin. But it’s flattened out, which can happen. So they are going to redo it for me. And they are going to, it’s slightly larger than the other one. I asked them if they could make the other one bigger [laughs]. I thought why not go bigger, why go smaller? But they said that if they did, it could look not quite so natural. So I’d rather go for natural. And so they are going to lipo some out and lipo some into a line I’ve got, and there are various things they are going to do to it. So it’s not, you know, it’s an ongoing thing but it’s still brilliant.

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Most women had surgery to the healthy breast several months after their mastectomy. One woman, though, said she’d waited over a year. She was planning to have her healthy breast reduced in size but chose not to have nipple reconstruction.

Jane has been waiting a year for her mastopexy, which was delayed for clinical reasons. She was…

Age at interview 59

Gender Female

Age at diagnosis 58

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When I talked to the plastic surgeon at the time of the operation, which is April, I said, Oh I would really like to get all this sorted out as soon as possible and I would like to have whatever stage two entails quite quickly. Do you think you would be able to do that in December And he said, Oh yes, probably we’ll be able to do that in December

But in actual fact he hasn’t been able to do it yet. So now we’re almost a year on. And I went to them in October. I went to see them before October and there were clinical reasons why they couldn’t progress to stage two. They said it was just simply, just a bit, the breast was still a bit too hard, the skin was just a bit too thin and they really wouldn’t want to do stage two yet. And that was fine. That’s fair enough.

But then in late October we had another consultation about what we would do in stage two, and we agreed that I would have the good breast slightly reduced and lifted. I don’t think it’s a reduction, it’s a, I think it’s called a mastopexy or something, where it’s just kind of tweaked to match. And that they would also do a little bit of liposuction on the reconstructed breast to give me this better shape under my arm.

And we had a long discussion about whether or not I wanted a new nipple and I think the doctors were slightly disappointed when I said I’m really not bothered either way and probably I won’t bother. And I’m still half expecting when I turn up in the hospital for stage two for them to say, Well are you sure you don’t want a nipple And I’m might give way at that point and think, Oh yes, for goodness sake, if you’d like to do one, do one [laughs]

But anyway, we went away from stage two and they said, Right, we’ll now put you down, Jane, for whatever we’re going to do in stage two And I went away thinking that I would probably hear within about 6 weeks or something like that, when I was going to have an operation. And then I phoned them in, earlier this month actually, to find out, very gently, what was happening. I wasn’t trying to say, you know, I want to get this done as quickly as possible, please do me now Because that’s pointless if people have more urgent things to be done. But I just wanted some sort of idea as to when it was going to happen. And I discovered what they hadn’t told me that on, after that October date, they can’t just go straight back to the hospital and say, Right book Jane in for as soon as possible It has to go to the primary health care trust and the primary health care trust has to decide whether there’s money and whether you can go on the list. And in fact when I started to phone around, I found out that they hadn’t got the OK from the primary health care trust until January. And I would have quite liked to have known that that procedure existed.

And I’m now trying to get in touch with admissions at the hospital to find out when I’m likely to be called and they’re quite difficult to contact and quite difficult to run. And I know it’s because they’re overworked and they’ve got a huge caseload. But it’s just, it’s slightly irritating from my point of view and I can, you know, this is where you’re quite tempted I would think to go private if you could. I can’t because it’s what, it’s classed as a kind of tidy up operation so you can’t do it privately. But I can imagine somebody thinking, Oh, for goodness sake, I’m not going to wait six months for the NHS to decide to do stage two, I’ll go ahead So that’s where I am no

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Some women said they didn’t have any surgery to the healthy breast or nipple reconstruction because they didn’t want any more surgery after their mastectomy and breast reconstruction.