Jamie's Blog

Thursday, July 1, 2010

The Ethics Of Nipple Reconstruction

It is truly amazing what surgeons can do for mastectomy patients who choose reconstruction.   Gone are the days when the only treatment for breast cancer was radical mastectomy, which removed not only breast tissue, lymph nodes, and nipples, but the underlying muscles, leaving women with concave, bony, and scarred chests.  

With advancements in screening and techniques today’s women can choose among several surgical options, from breast conserving “lumpectomy,” to nipple-sparing mastectomy, to mastectomy with reconstruction of the entire breast, either with implants or autogenous tissue taken from the patient’s body.

Wait, there’s more.   For women who select the DIEP flap procedure, where the tissue is taken from the abdomen, they get a tummy tuck in the process—an extreme makeover courtesy of insurance!
Nowadays women can even choose whether or not they want replacement nipples; and many opt for nipple reconstruction and areola tattooing.  This is the choice I made.  Reconstructed nipples are notorious for losing their projection, so my surgeon saved some of my cartilage to provide a permanent point under the nipple. I thought it was a genius idea.

That was 4 years ago.

Don’t get me wrong:  I love my breasts, and l trust my surgeon:   AND I wish I didn’t have nipples that are always at attention but never any fun.  Wherever I go, whatever the climate, it is always winter but never Christmas.

Question: why bother?   Why subject ourselves to another hospital stay, another surgical procedure, another recovery time, for a temporary fix?  Why not go straight to a professional tattoo artist who can do this:

I put the question out there for my survivor sisters:  what do you think? What have you experienced? Please add to the discussion so we can improve the options for future sisters.
Permanent Areola Repigmentation And Nipple Restoration by Melany Whitney


  1. I don't have the "always winter" problem, mine is pretty normal all the time and because I have always personally found it distasteful to see nipples showing, I always have a bra that wouldn't show if it was "winter" or not....however, my problem has been that the tattoo has faded...I have had it done more than once and it again in time fades...not doing it again...

  2. I chose the tattoo but not the permanent stand up nipple, I like being able to wear clothes without having them show. Life is good and I'm very happy without them.

  3. Thank you both for sharing your experiences. The important thing is that we are alive! Being pleased with the cosmetics just makes living easier.

  4. From my standpoint, I think that nipple reconstruction (including tattooing) adds immensely to the final result. I have had many patients who have told me that until their nipples were made and tattooed, they were reminded of their status each time they got out of the shower; once it was done they felt more normal. For this reason I encourage my patients to complete their reconstruction.

  5. Thank you for your thoughts. I would expect nothing less of you, i.e, that you would be motivated by your patients' desire to regain a
    sense of normal.
    My followup question for you is if you offer patients just tattooing to spare them another surgery, for the reasons I discuss in the blog?

  6. Nipple reconstruction is a very minor operation - compared to the DIEP especially - which can be done under local anesthesia. Nipple projection is a very personal reference. Some patients want none - those patients can have tattooing alone, and I have done that for a few patients. But most patients want some projection, and for them, I recommend nipple reconstruction + tattooing.

  7. Good question. I am scheduled to have my nipple done in September and I had not realize that there was a choice about projection to consider. Sigh. Always something. I suppose that I will have it project a bit because my natural breast (since the reduction a few weeks ago) seems to be constantly at attention too.

  8. Jamie: The farm families who own Cabot want to thank you for all the good work you are doing, so you've been selected for a Random Act of Cheddar. You can read about it at www.givecheddar.com and you can nominate someone there too. Email wendy@cabotcheese.com with your address and get the ball rolling. Thanks, Candace

  9. Question: Where did the cartilage come from??? Wish I had known about that option. I did the nipple recon twice. It fell twice. I'd rather have them up all the time than never really up.

  10. Cartilage came from the rib. Surgeon sewed it into my abdominal incision for safe keeping until the nipple reconstruction. The problem with the nipple is that it is a tiny little point, about the size of a small mole; nothing you can sink your teeth into, if you get my drift!

  11. I know I will feel more comfortable about myself if I have something that looks like a nipple.

  12. Jamie,
    This is an excellent oct that I would have missed the first time you wrote it... I wasn't in the blog world until July 2011.

    I opted for nipple reconstruction followed by tattoo (I had implant surgery so it's an option there, too). The procedure was done using my own skin for the "protrusion" ..... They did lose some of their protrusion. There is now a hint of a headlight in certain clothes. I've gotten bold and there are times I will purposely choose an outfit and go braless. I think of Sex and the City when they bought those fake things. I THINK some of this "bold" behavior has more to do with my compromised chemobrain and a loss of impulse control (Joking and laughing here!)

    The tattoos were the icing on the cake. They have faded a bit but to be honest, I was never particularly fond of the shade. Rather than a touch up in the docs office, I plan on going for the 3D tattoos once the summer is over.

    Love LOVE your observation--- "always winter but never Christmas" .... Yeah... that bugs me too....

    Great great GREAT post!


    1. Thank you always for your wonderful words of affirmation. I do enjoy going commando at my age!

      (BTW, I can't take credit for "always winter but never Christmas" which is from "The Lion The Witch and The Wardrobe" by CS Lewis)

  13. So... quick question. Is cartiledge needed? Or can the nipple be surgically created without it?

    1. Not needed. In fact, I hear that the results are better without it. Are you considering nipple reconstruction?

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    درب اتوماتيک شيشه اي



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