Making the decision about nipple replacement after mastectomy can be extremely difficult. On one hand, you would love to feel like your reconstruction is “finished.” On the other hand, the thought of “one more surgery” is enough to make you crazy!
I’ve TOTALLY been there, my friend!
(In fact, I blogged my cancer journey as I lived it. If you want to read more of my story, head over to this page. It will open in a new tab, so you won’t lose your spot in this article…)
Today I wanted to outline the five main choices when it comes to nipple replacement/reconstruction for those of you who are facing this decision. In another post I will share with you my own decision and experience with nipple reconstruction.
As a side note: This is for educational use only and is not to be taken as professional advice. I am sharing these options through my own research online and discussion with my plastic surgeon. In no way do I intend for this to take the place of consultation with your own medical professionals.
Here are the five main options when considering if/how you want to replace your nipples following mastectomy:
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OPTION #1 – DO NOTHING
Yep. This is TOTALLY an option. Don’t feel like you HAVE to go through another surgery! Many breast cancer survivors leave their reconstructed breasts as-is! Here is me rocking my t-shirt with smooth-as-Barbie boobs before my nipple reconstruction:
PROS
- No more surgery!
- Your chest looks super smooth in t-shirts.
CONS
- Visual reminder of cancer
- Mastectomy scars are more evident
OPTION #2 – PROSTHETIC NIPPLES
You read that correctly. Prosthetic nipples are a thing. I actually didn’t realize this until the morning of my own nipple reconstruction surgery. Just before going under the knife, my plastic surgeon put prosthetic nipples on my chest to gauge the correct nipple placement. (Now THAT was an odd experience…more on that in another post.)
The prosthetic nipples are usually made from skin-safe silicone and are applied with a special adhesive that stays in place through showers, swimming, intimacy, and more.
PROS
- Great option for women who are unable to have nipple grafts (due to radiation or some other reason), had a failed nipple graft experience, or who have to wait an extended period of time before grafts
- There are some inexpensive options. Amoena (the company that made my favorite post-mastectomy camisole) actually sells several different colors of prosthetic nipples on Amazon.
- Some prosthetic companies, like Pink Perfect, will create a prosthesis from an impression of your existing nipple. This is a great option for symmetry if you did not have a bilateral mastectomy.
- There is no risk of infection or surgical complications.
- Insurance might reimburse you for some of the cost (depending on your insurance coverage and how/from where you purchase them)
- Prosthetic nipples help to cover mastectomy scars and they make your breasts look more natural.
CONS
- Prosthetic nipples require ongoing cleaning, care, and eventual replacement.
- Prosthetic nipples can be expensive. Custom-made prosthetic nipples from an impression could start at close to $500 for the pair (according to Pink Perfect’s website)
- There is a potential for skin sensitivity to the prosthetic nipples and/or the adhesive.
- Getting the prosthetics placed “just so” could take some practice.
- Less natural during intimacy
OPTION #3 – TEMPORARY TATTOOS
I learned something new when researching for this post. I didn’t realize that there were rub-on temporary tattoos of nipples for women who have gone through mastectomy.
Just as with the prosthetic nipples, there are various ranges of quality and cost and they are meant to last for a week or two.
PROS
- Readily available and easy to order (you can even find some brands on Amazon…like this one)
- A great option for “testing out” nipple replacement.
- Easy to put on and remove
- Relatively inexpensive for short-term use
CONS
- Require continual replacement, which can be expensive over time
- There could be a learning curve for symmetrical application
- Some reviews that I have read state that users did not get the advertised results for longevity.
OPTION #4 – TATTOOING
Tattooing is often used on its own as an alternative to nipple reconstruction. It can also be used in combination with nipple reconstruction, especially if the skin grafts do not maintain a pink color after surgery.
There is a very informative FAQ with Vinnie Myers, nipple tattoo artist, on breastcancer.org that sheds additional light on this process.
PROS
- No surgery!
- With the right tattoo artist (one that specializes in 3D medical tattooing), they can look remarkably realistic
- Since women have limited sensation following mastectomy, the process is not very painful (from what I’ve read)
- Covers mastectomy scars and makes breasts look more natural.
- Breasts can be tattooed with other meaningful images instead of nipples.
- Smooth skin surface will still look great in t-shirts
- Depending on your situation, insurance could cover some of the cost
CONS
- There is potential for fading over time.
- Risk of infection (which should be minimized if you choose the right artist)
- The lack of nipple structure can look and feel unnatural in certain situations (ie: when swimming, during intimacy)
- Depending on the artist, it can be a fairly expensive process, especially if insurance does not cover the cost
OPTION #5 – SURGICAL NIPPLE RECONSTRUCTION
When you hear “nipple reconstruction,” this is typically the option that you think of. This is the most involved of the four options I am sharing with you today. There are actually a few different types of surgical nipple reconstruction that your surgeon might recommend, or maybe (like in my case) a combination.
PROS
- The reconstructed nipples actually do a great job at covering mastectomy scars, or at least drawing attention away from them.
- This is a permanent option that should not require “touching up” (after the initial surgery recovery with any necessary revisions)
- This is the most natural look of the four options and will help the breast reconstruction look “finished”
- Insurance usually covers most (or all) of this reconstruction
- More natural feel during intimacy (mostly for partner…see cons)
- Reconstructed nipples will have structure but should still look smooth in a t-shirt
CONS
- Even though they look super natural, there is usually no sensation in reconstructed nipples.
- Requires surgery with general anesthesia and a fairly involved recovery, due to care of skin grafts and incision sites
- There is a small possibility for the grafts to fail
- There is a risk of infection following surgery
- As with all plastic surgery, perfect results and symmetry are not guaranteed.
- Might still require tattooing in order to obtain desired results
As you can see, there really is no “perfect choice” when it comes to dealing with nipples after mastectomy. That’s what makes it such a tough decision!
One thing to keep in mind is that there is nothing pressing you to make this decision right away. Any delay is really just giving the skin on your breasts more time to heal. (The only timeline you MIGHT want to pay attention to would be your insurance coverage.)
Just make sure your final decision is YOUR decision. If you do that, you’ll be happy with whatever you choose because it was the right choice for YOU.
The last thing I will say is this: If you opt to do something about your nipples, I think you’ll be pleasantly surprised at what a difference it makes in your mental and emotional recovery from breast cancer. I know I was!
I wish you the very best as you consider your options for nipple replacement following mastectomy.
HUGS! – Stephanie
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