NIPPLE RECONSTRUCTION SURGERY: WHAT YOU SHOULD KNOW

You did it! You have made it through one of the hardest experiences you will ever endure in your lifetime. You have made REALLY hard decisions about your treatment and surgery. You’ve also made some hard decisions about your reconstruction. Today I want to talk to those of you who have decided on nipple reconstruction surgery, because I think there are some important things you need to know!

There really wasn’t a whole lot of practical information online when I was preparing for my nipple reconstruction. In fact, the only real information I received was that it was an “easy little surgery” tacked onto the end of my reconstruction.

The icing on the cake, if you will.

At least, that’s how my plastic surgeon presented it to me.

Now that I’ve come out the other side, there are definitely some things I wish that I had known before having nipple reconstruction surgery. Since I am a chronic oversharer, I decided to pass along my thoughts to YOU!


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I just want to get one more disclosure out of the way before we start: This post has the potential to make things awkward between us if you see me in the supermarket.

There are photos of my recovery bandages (although I have chosen to not show my actual nipples) and you will see some skin. You will also hear some details that will border on TMI, especially if this is not a surgery you have to endure yourself. If you think that any of this will bother you, I suggest that you skip this post. No hard feelings.

Now…on to what you need to know:

IT IS A SIGNIFICANT SURGERY

Yes, it might be an “easy little surgery” for your plastic surgeon, but it’s still a significant surgery.

You’re still being put under general anesthesia.

You still have a significant recovery period (more on that below).

You will want to make preparations for yourself post-surgery just like any other surgery. (You need someone to drive you home, your lifting will be limited, you want shirts that are easy to put on and take off, etc.)

THE RECOVERY IS VERY INVOLVED

If I had to rate my breast cancer-related surgeries in order from easiest to most difficult in terms of recovery, it would go as follows:

  1. Oophorectomy
  2. Implant placement
  3. Nipple reconstruction
  4. Bilateral mastectomy

Yes, you read that right. I felt like the nipple reconstruction was second only to my actual mastectomy when it came to the involved nature of the recovery period.

The reason for this is the fact that it is a skin graft. You have to baby these grafts so that they will survive! You can’t shower for the first week while the dressings are on. After the surgical dressings come off and you can shower, you still have to wear gauze and tape for WEEKS.

(This is DEFINITELY when you want to use the convenient shower wipes that I mentioned in the mastectomy post.)

The risk of infection is high, so you also have to be religious about putting antibiotic ointment on the surgical site.

You also have activity and lifting restrictions because you really don’t want things to bump up against your grafts. There aren’t hard-and-fast restrictions (it depends on your surgeon), but you definitely need to be careful!

On top of that, you have the site of your donor skin that is trying to heal at the same time. My donor skin came from my lower belly, on each side of my C-section scar. Since the donor skin was removed as a large circle, the plastic surgeon did a small tuck at each incision site. Enter the tummy tuck support band. Oh, goody!

Sorry if this is “too much.” Honestly, you see worse when you watch the Grammys.

Honestly, I felt like my recovery from the nipple reconstruction was similar in obnoxiousness to that of my C-sections. Even though the incisions did not go nearly as deep, they were still in a very difficult place; after I was done with the tummy tuck band, the incisions would still rub against my waistbands and get sore very easily!

I would suggest that you ask your surgeon where he/she thinks your donor skin will come from, so that you can be prepared with whatever clothing you might need to be comfortable.

YOU PROBABLY WON’T FEEL ANYTHING

I hope I haven’t scared you up to this point! I will get around to telling you whether I think it was worth it.

One positive thing to consider is that you probably won’t feel anything at the actual surgical site as your grafts recover. Any pain you feel will come from your donor skin sites.

I also just wanted to clarify that this means you won’t magically have feeling in your nipples after the reconstruction. I have experienced some signs that my nerve endings are reconnecting (mainly ITCHING!!), but everything is still pretty numb in my chest. Including my new nipples.

YOU GET TO DECIDE ON YOUR NIPPLE PLACEMENT

If your plastic surgeon is anything like mine, he/she will put some prosthetic nipples on your chest prior to surgery in order to determine the best placement of your grafts.

In order to determine this placement, he/she will probably ask for your opinion.

This took me completely off guard! I must say, I had never really thought about the placement of my nipples before.

So there I was, on the morning of my surgery, looking down at these little silicone nipples and wondering if that’s where I thought they should be.

I had no idea.

After standing there for a second, I finally decided that my surgeon had made them a little too “perky” so we lowered them a tad, but the whole thing had me chuckling to myself because I was so unprepared for that conversation!

So this is me telling YOU that you should think about these things prior to the morning of your surgery! You can even find temporary nipple tattoos or adhesive nipples to help you experiment with this in the comfort of your own home.

YOU WON’T BE SYMMETRICAL

As hard as the surgeon tries, there really is no way that you will end up perfectly symmetrical.

Even if your surgeon is the best there is, each graft will heal differently and might be a slightly different size.

I speak from experience (more on that in a minute).

YOU MIGHT LOOK…UM…POINTY

The post-op dressing that my surgeon used included surgical sponges that had a hole cut in them to house and protect the nipple. They were pretty dang three-dimensional!

This is the surgical sponge stitched to my skin.

In fact, I ended up looking like Madonna circa the cone bra era.

You might experience the same, so be prepared to wear some flowy tops for the first week if you don’t want to lead with your nips!

YOU MIGHT HAVE HAIRY NIPPLES

Yep, I’m going there.

I’m not talking about the normal hair that grows around the areola for some of you lucky ladies (I was one of them). I’m talking about full-on hair growing right out of the tip of your nip.

Your surgeon will try to take the donor skin from a part of your body with the least amount of hair-growing capability. But, y’all, bodies have peach fuzz.

And I’ve had my share of long peach-fuzzy hairs poking out of my new nips.

It cracks me up, personally, but I thought you should know!

YOUR NIPPLES MIGHT NOT BE PINK

As your nipples heal, they might lose some of the initial pinkness that is common in fresh skin grafts. So you might still consider tattooing your nipples.

I’m still on the fence about that. I’m waiting to see if I lose any more color.

YOU MIGHT NEED A REVISION

Remember when I told you about the lack of symmetry? Well, sometimes the lack of symmetry is so noticeable that the plastic surgeon opts for a revision.

I had one of those.

My surgeon was generous when building my nipples because the skin naturally retracts as it heals. I had one nipple that retracted probably a little bit too much and one that didn’t retract.

At all.

I was left with this super long nipple that didn’t even come CLOSE to matching the other side.

Cue the revision.

This part WAS a simple surgery, where I was given local anesthesia and, five minutes later, I had a nipple that had been cut down to size. The recovery was just a waterproof bandage that needed to be changed with every shower.

Easy peasy.

YOU MIGHT NEED A BRA

I loved my pre-nipple reconstructed boobs because they were SO smooth! I was able to go without a bra all the time, with any shirt. (My implants are small and perky enough that it is actually more comfortable for me to go without a bra.)

However, even with my revision, the bump of one of my nipples shows through some fabrics. So I have to wear a bra to cover up my nipple with certain outfits.

Just keep that in mind!

NIPPLE RECONSTRUCTION SURGERY IS WORTH THE TROUBLE

This last “tip” is definitely subjective, but I wanted to end with my opinion.

All things considered, I really do think that nipple reconstruction surgery is worth the trouble. At least, it was for me.

It provides a type of closure that I really didn’t know I needed until the surgery was done and my recovery was finished. When I pass the mirror after my shower, my brain is no longer startled by Barbie boobs with long Frankenstein scars.

Now my brain chills out a bit because it sees nipples where nipples should be.

(Although they might be a little bit perkier than it remembers.)

Have you had nipple reconstruction surgery? What would you add to this list?

12 thoughts on “NIPPLE RECONSTRUCTION SURGERY: WHAT YOU SHOULD KNOW”

  1. I’m just in the beginning stages of this journey ( I start chemo next week) but thank you so much! I have so many decisions to make in the coming months so it’s nice to have the wisdom of someone who has already walked this path.

  2. I’m 6 weeks out from bilateral mastectomy with immediate reconstruction (DIEP flap) and am still undecided about nipple reconstruction. Thanks for breaking it down in an honest and straightforward way. No one understands better than someone who has “been there, done that”!! This definitely helps!

      1. I’ve just booked reconstruction surgery in feb next year. Surgeon advised me to start thinking about nipple reconstruction. Thx for sharing your journey. I don’t feel as petrified as I was before reading this 💙

  3. Thank you so much for sharing. I’m 2 weeks out from a double mastectomy with reconstruction. I have chemo starting in 3-4 weeks. I have to say the expanders are not my favorite. I feel like they’re sticking out under my arms. Anyway I was planning on the nipple reconstruction but I’m starting to lean towards 3D nipple tattoos. I have time but you’re post was very helpful. Thank you

    1. I’m so sorry that you have to walk this path, Lisa! I agree…the expanders were very uncomfortable at first. They are never super comfortable, but it does get better after they have some volume. Good luck as you continue on with your treatment and other decisions. Hugs and best wishes!

  4. When my 24 yr old daughter chose nipple reconstruction post bilateral mastectomies, the donor skin was taken from her outer labia, because the surgeon felt the natural skin tone/texture was best suited for building nipples. The donor sites were very uncomfortable, but I bought her mens’ long briefs to wear while healing, which she loved! It’s been 11 years and she recently stated that she is happier with her choice now than she was originally, once she was all healed and past treatment,

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