The Crowning Touch: How Nipples Are Reconstructed After a Mastectomy
Let's talk about nipples—and how there are more postsurgical options available for breast cancer patients than ever before.
Illustration: Libby Vanderploeg
If you do choose to have your breasts reconstructed after a mastectomy, they’re likely to be completely smooth and round (“Barbie boobs,” some call them). Yet for many women, a nipple is what makes the breast a breast, so the right cosmetic touch can provide a psychological boost and a connection to their precancer self. While it’s not possible to restore nipple sensation or function once nerves are severed, there are now boldly artful ways to re-create (or save) one of nature’s most exquisite anatomical flourishes.
Nipple-Sparing Mastectomy
This technique, a variation of skin-sparing mastectomy, was first used in the 1960s only for benign tumors. While it’s still not considered a standard breast cancer treatment by all experts, interest in it spiked after Angelina Jolie wrote about a version of this procedure for her prophylactic double mastectomy in 2013. Instead of removing the entire breast, surgeons take out all the breast tissue through a small incision. However, not everyone is eligible: Women who have tumors close to the nipple or extensive cancer in the milk ducts might be in danger of a recurrence if the nipple is preserved, says Elisa Port, MD, chief of breast surgery at Mount Sinai Hospital in New York City. (Also, the surgery tends to produce the most satisfactory aesthetic results in breasts that haven’t yet succumbed to gravity’s pull.)
Surgical Reconstruction
After the implant has settled into place, a surgeon can create a nipple with skin from the breast itself. A cosmetic filler or fat graft is sometimes used to give the new nipple more lift. For patients having a unilateral mastectomy, the surgeon can also remove a portion of the healthy breast’s nipple and attach it to the reconstructed breast. (Sensation in the healthy nipple is often unaffected.)
Tattoos
Like all tattoos, nipple tattoos are flat, but a skilled artist can make them look amazingly three-dimensional. Paying $600 to $800 for two nipples is common—and may be covered by insurance. Tattoos are usually added a few months after reconstruction, says Tara Dunsmore, a nurse and breast cancer survivor who owns Pink Ink Tattoo in Raleigh, North Carolina. Patients should ask to see examples of work, whether the person doing the ink is a nurse, a doctor, or a tattoo artist at a medical practice or an independent shop. Make sure an outside tattoo artist is licensed and familiar with the considerations of breast cancer survivors, including thinner breast tissue and the presence of implants, advises Vinnie Myers, who specializes in nipple and areola tattooing in Maryland. Not ready for the needle? Temporary tattoos like Rub-On Nipples come in nine shades, can stay on for a week or more, and are removed with rubbing alcohol, says company founder Elizabeth Vivenzio, who had a risk-reducing mastectomy in 2009.
Prosthetics
Realistic-looking silicone nipples can be attached to a reconstructed breast using a waterproof adhesive. Michelle Kolath-Arbel, owner of Pink Perfect, who herself lost a breast to cancer, will craft a custom nipple prosthetic (starting at $410 for six—insurance may cover it), or customers can choose from eight colors and three styles of ready-made nipples ($280 for two). The adhesive will stick for several days; the nipples themselves will stay perky for years.
Nipple-Sparing Mastectomy
This technique, a variation of skin-sparing mastectomy, was first used in the 1960s only for benign tumors. While it’s still not considered a standard breast cancer treatment by all experts, interest in it spiked after Angelina Jolie wrote about a version of this procedure for her prophylactic double mastectomy in 2013. Instead of removing the entire breast, surgeons take out all the breast tissue through a small incision. However, not everyone is eligible: Women who have tumors close to the nipple or extensive cancer in the milk ducts might be in danger of a recurrence if the nipple is preserved, says Elisa Port, MD, chief of breast surgery at Mount Sinai Hospital in New York City. (Also, the surgery tends to produce the most satisfactory aesthetic results in breasts that haven’t yet succumbed to gravity’s pull.)
Surgical Reconstruction
After the implant has settled into place, a surgeon can create a nipple with skin from the breast itself. A cosmetic filler or fat graft is sometimes used to give the new nipple more lift. For patients having a unilateral mastectomy, the surgeon can also remove a portion of the healthy breast’s nipple and attach it to the reconstructed breast. (Sensation in the healthy nipple is often unaffected.)
Tattoos
Like all tattoos, nipple tattoos are flat, but a skilled artist can make them look amazingly three-dimensional. Paying $600 to $800 for two nipples is common—and may be covered by insurance. Tattoos are usually added a few months after reconstruction, says Tara Dunsmore, a nurse and breast cancer survivor who owns Pink Ink Tattoo in Raleigh, North Carolina. Patients should ask to see examples of work, whether the person doing the ink is a nurse, a doctor, or a tattoo artist at a medical practice or an independent shop. Make sure an outside tattoo artist is licensed and familiar with the considerations of breast cancer survivors, including thinner breast tissue and the presence of implants, advises Vinnie Myers, who specializes in nipple and areola tattooing in Maryland. Not ready for the needle? Temporary tattoos like Rub-On Nipples come in nine shades, can stay on for a week or more, and are removed with rubbing alcohol, says company founder Elizabeth Vivenzio, who had a risk-reducing mastectomy in 2009.
Prosthetics
Realistic-looking silicone nipples can be attached to a reconstructed breast using a waterproof adhesive. Michelle Kolath-Arbel, owner of Pink Perfect, who herself lost a breast to cancer, will craft a custom nipple prosthetic (starting at $410 for six—insurance may cover it), or customers can choose from eight colors and three styles of ready-made nipples ($280 for two). The adhesive will stick for several days; the nipples themselves will stay perky for years.
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