Nipples - Choices!

NIPPLES!

This may seem like an odd subject for the "looking good/feeling great" tab but if you've had a mastectomy it can be the cherry on the cake (apologies for the pun!) to have nipples again!  Many people don't realise there are choices - but there are, so let's explore the options!

CHOICES TO ASK ABOUT BEFORE SURGERY:

There are a small minority of patients who have had a mastectomy who have kept their nipple intact and working.  This is obviously only if this is advised by the surgeon as it does mean you leave behind some tissue which of course is not what you want when you have a mastectomy - however, depending on your type of breast cancer and position of the tumour, it may be possible.  I must stress that keeping a working nipple really is only for a minority of ladies.

If you're interested in keeping a functioning nipple then of course you must ask your surgeon before surgery.

The choices, in most cases, are as follows and will give you nipples but non-functioning ones:-

1.  Having a small nipple created by using skin to give a "bump" that can either have a tattoo around it or not.

2.  Having a tattoo to represent a nipple - either 3D or normal.  They can simulate a raised nipple area in the centre or can use the small reconstructed nipple as in 1 above.

3.  Free Nipple Graft - this is where your own nipple is taken off during surgery, completely thinned out to minimise the risk of retaining tissue, then sewn back on to the reconstructed breast in the same surgery. Not all surgeons can do this specialist type of surgery.

4.  Temporary week long tattoos that can be applied whenever you want.

5.  Suction/vacuum applied nipples.

Let's explore each option in a little more depth:

RECONSTRUCTED NIPPLES

1.  This is a photo of a reconstructed nipple.  You can see that it is just a small mound but has no colour.  This can give the illusion of a nipple and typically reconstructed nipples are either carried out at the same time as mastectomies or at a later date when the mastectomy has healed.  I'm assuming each surgeon has their own preferred timeline so it's best to check with yours.  The advantage of having this type of surgery is that, even without the colour of an areola, it does look natural.  The downside is there is no sexual feeling and that you will always have an erect nipple - so if you don't wear a bra, this may show through some clothes.  This is definitely something you should take into consideration.

TATTOO'S - 3D AND NORMAL

2.  Many ladies opt to have nipples tattoo'd on when their mastectomies have healed well enough.

There are many tattooists that can do this (both on the NHS and private) but do your research to find one that you like their work.  You should be given a choice of colour and size but be prepared that tattoos do fade so initially the tattoo will look darker and become more natural looking as it fades.

Unfortunately the downside with having a tattoo is that you may need to have the colour topped up to keep the nipple at the colour you like.  It's unlikely to fade to nothing so you will still have an areola but a paler one (some people have these naturally so it will still look "normal").

On the right at the top of this sesction, you can see a 3D reconstruction by a lady called Vicky Martin (you can find her on Facebook under Vicky Martin 3D Areola).  As you can see in this photo, this lady does not have a reconstructed nipple so Vicky has created the illusion of one.  Honestly, I think her work is amazing and I was going to opt for this before my surgeon offered me a different route (see below).

Here's another example of Vicky's work but you can see that this lady has had a nipple reconstruction so there's a small bump.

Vicky has tattoo'd around the bump and on the bump too to create a natural looking nipple.

I understand from ladies who have had this done that sometimes the bump flattens out a bit straight after the tattooing but then does plump up again with a few weeks.

One thing that might surprise you is that tattooing isn't as painful as you may imagine but many ladies have limited feeling in their reconstructions.  Of course, it's not like having your hair done and there will be some sensitivity but possibly not as much as imagined.

FREE NIPPLE GRAFT

3.  A free nipple graft is not something that all surgeons can do as it's a specialist type of reconstruction.  Also, it's not suitable for everybody as it does retain a small part of your own tissue.  Therefore, in order to be eligible to have this procedure, your tumour must be significantly far from the nipple area to avoid any stray cancer cells.  Your surgeon will be able to tell you if you're eligible and whether they offer this procedure.

How it works is that during your mastectomy, your nipples are removed and then painstakingly thinned out (and made smaller to fit your new breasts if needed).  A blood supply is then created in the centre of your breast and your nipples are reattached. 

After surgery, your nipples have to remain covered for at least 2 weeks and must not get wet.  This allows for the blood supply to "take" and for the nipple to remain alive.  In certain cases, small areas of the nipple don't "take" and it may look quite white where the area has died.  This can always be tattoo'd on later to even out the colour.

As you can see in my photos, I was lucky that my nipples all took but I had a mishap with an ill fitting post mastectomy bra that squashed one during the healing process.  This has meant that my nipples are not symmetrical and I was a bit unlucky but having said that, they are my nipples and although they don't work, they won't fade either - so they're low maintenance nipples!!!!

Like having a nipple reconstruction, my nipples are permanently erect and so I have to either wear a bra or be aware of what I'm wearing!  This isn't something I had thought about beforehand! 

I am very pleased with my nipples and the fact that they're mine is of course a bonus.

TEMPORARY NIPPLES

4.  If you don't want a permanent nipple and can't face the prospect of tattooing (possibly you have a needle phobia), there are quite a few options for temporary stick on nipples.

Some don't last more than a few hours but here is a company called "Tattoos for a Week" that have a huge selection of temporary nipples in all sizes and colours.

These are applied and then removed with a liquid they provide (although I suspect a good oil would remove them too).  The beauty of these are that they are supposed to last a week so they are very cost effective.

I haven't used these but do know people who have.  I'd love to hear of your experience with them and whether you've found them good or not.

Suction/Vacuum Applied Nipples

5.  One of my friends saw my "nipple" page and told me of another option that I hadn't heard of. 

This procedure basically takes a mould of your existing nipple (so if you're having a double mastectomy you might need to do this before surgery).

My friend went into her local hospital where they applied a warm flannel on her nipple, then siliconed over to make mould.  It was then colour matched to her existing nipple and a week later it arrived in the post!

To stick it on, you apply a thin lyer of vasoline to the back of the silicone nipple, put it in place and push the nipple centre which creates the suction,  The edges are then flattened out by gently pushing to mould to the breast tissue.  I'm assuming if you wanted added security, you could even add a small amount of eyelash glue (perhaps around the inside outer edge) although I'm guessing at that part and it may not be practical or feasible.  Thank you to my friend, Angela, for the information and photos.