Medical Oncologist
CION Cancer Clinics
Nipple and areola reconstruction: the last step, and an optional one | CION Cancer Clinics
Nipple reconstruction is a small operation, usually under local anaesthetic as a day case, that folds skin on the new breast mound into a nipple shape. The areola is then added by tattoo. It is done months after the breast has settled, it is optional, and a shaded tattoo alone or a stick-on nipple are fair alternatives. This page explains the choices, what happens on the day and what a new nipple cannot do. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is nipple and areola reconstruction after a mastectomy?
- What are the options for a nipple after mastectomy?
- What actually happens at a nipple reconstruction?
- A reconstructed nipple and a tattoo alone, compared
- Words you will hear, in plain language
- Four things families tell us, and what is actually true
- Who it does not suit, and what this page cannot tell you
- Common questions about nipple reconstruction
The short answer
What is nipple and areola reconstruction after a mastectomy?
Nipple reconstruction is a small operation, usually done under local anaesthetic as a day case, that folds the skin on the new breast mound into the shape of a nipple. The darker circle around it, the areola, is then added by tattoo or, less often, a skin graft. It is the last step of a reconstruction, and it is entirely optional.
Why it is done last
The nipple has to sit in the right place on the finished breast. So the team waits until the breast mound has healed and settled, which usually means several months after a flap or the final implant, and after any radiotherapy has finished and the skin has recovered. A nipple placed too early can end up off-centre as the breast settles.
What it gives you, and what it does not
It gives the breast a finished look, in clothes and out of them, and many women say it is the point at which the reconstruction feels complete. It does not give you a nipple that feels, that responds to cold or touch, or that can breastfeed. It is a shape, made of your skin, with colour added.
If you had a nipple-sparing mastectomy, your own nipple was kept and this page does not apply to you.Your choices
What are the options for a nipple after mastectomy?
A nipple made from local skin
The surgeon cuts small flaps of skin on the breast mound, folds them up and stitches them into a raised bump. The base heals as a small scar. Under local anaesthetic, home the same day.
Good to know
- Loses some height over the first year
- Needs the areola coloured in afterwards
Tattoo for the areola
A medical tattooist or nurse adds colour in a circle around the new nipple, matched to the other side. Done a few months after the nipple has healed, in a clinic chair, and touched up as it fades.
Tattoo alone, with shading
A skilled tattooist shades a nipple and areola so it looks raised without any surgery. Nothing to heal, nothing to stitch. It is flat to the touch, which suits some women well and others not.
A stick-on nipple
A soft silicone nipple, colour-matched, that sticks to the skin and comes off at night. Useful while you decide, or instead of surgery. Not usually covered by schemes, and it wears out.
Not sure whether this applies to you?
Ask an oncologistOn the day
What actually happens at a nipple reconstruction?
Marking, sitting up
With you sitting, the surgeon marks where the nipple should sit, matching the other side if you have one. You are shown in a mirror and asked to agree the position, because this is the moment to change it.
Numbing the skin
Local anaesthetic is injected around the marked area. It stings for a few seconds and then the skin goes numb. Most people have no general anaesthetic and eat normally beforehand.
Folding and stitching
Small flaps of skin are lifted, folded together and stitched into a raised bump. It takes well under an hour. You may feel pulling but not pain. If a skin graft is planned for the areola, that is taken and stitched on now.
Dressing and home
A protective dressing or a small shield goes over the new nipple so nothing presses on it. You go home the same day with instructions on keeping it dry and when to come back for the stitches.
Side by side
A reconstructed nipple and a tattoo alone, compared
Reconstructed nipple plus tattoo
Shaded tattoo alone
Raised, so it shows through thin clothing like the other side
Flat, so nothing shows through clothing
A small operation with stitches and a wound to heal
No surgery; a clinic session and a few days of tenderness
Loses some height over time and may need a repeat
Fades over the years and needs touching up
Not usually done on very thin or irradiated skin
Can be done on almost any healed skin
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In the clinic
Words you will hear, in plain language
- Areola
- The darker circle of skin around the nipple. It is recreated with colour, not with a raised shape.
- Projection
- How far the nipple stands out from the breast. A reconstructed nipple is made taller than needed because it settles over the first year.
- Local flap
- Skin lifted from right beside the nipple site and folded to make it. Named after their shapes, such as a star or a C-V flap; the name does not matter to you.
- Nipple-sparing mastectomy
- A mastectomy that keeps your own nipple and areola. If you had one, no nipple reconstruction is needed.
- Symmetry
- Matching the two sides in position, size and colour. The surgeon matches the new nipple to your remaining one, or makes both if both breasts were rebuilt.
Commonly believed
Four things families tell us, and what is actually true
"It is just cosmetic, so it is not worth bothering with."
For many women the nipple is the point at which the reconstruction stops looking like surgery and starts looking like a breast. It is small, quick and low-risk. Whether it is worth it is for her to decide, and not bothering is a fair choice too.
"The new nipple will have feeling."
It will not. It is made of skin whose nerves were cut at the mastectomy, and it does not respond to cold or touch. Anyone expecting sensation will be disappointed. Anyone expecting a shape that looks right in and out of clothes is likely to be pleased.
"The tattoo is done in a tattoo parlour."
Medical tattooing is done in a clinic by a trained nurse or medical tattooist, with sterile equipment and pigments chosen to match skin. Some specialist tattoo artists also do this work well. Ask your team who they use.
"If it is done straight after the breast surgery, it saves a trip."
It saves a trip and often costs the result. The breast mound moves as it heals and settles, and a nipple placed early can end up in the wrong place. Waiting until the breast has settled is why the team asks you to come back.
Being straight with you
Who it does not suit, and what this page cannot tell you
A surgical nipple is not offered where the skin is too thin or too damaged to fold safely. That includes skin over an implant that has become very thin, and skin that has had radiotherapy and is still tight or discoloured. In those cases the team usually suggests a shaded tattoo instead, which asks nothing of the skin.
Timing you cannot skip
If you are still having chemotherapy, or radiotherapy is planned, the nipple waits. Wounds heal poorly during treatment, and a nipple made before radiotherapy can flatten or lose its colour. Your surgeon will set the earliest date, and it is usually later than people hope.
What the page cannot tell you
It cannot tell you whether to have one. Some women feel finished without a nipple; some feel unfinished until it is there. Neither is the right answer. It cannot tell you how your result will look, because that depends on the skin and the mound underneath. And it has nothing to say about the cancer. A nipple reconstruction is done on healed skin, long after the cancer surgery, and does not affect follow-up.
Questions we are asked
Common questions about nipple reconstruction
How long after reconstruction can the nipple be made?
Usually several months after the breast mound has settled, and after any radiotherapy has finished and the skin has recovered. Your surgeon sets the date on how the breast looks, not on the calendar. The areola tattoo follows a few months after the nipple has healed.
Does it hurt?
The local anaesthetic injection stings briefly. After that you feel pulling but not pain, and the skin of a reconstructed breast is often numb anyway. Afterwards it is tender for a few days and ordinary pain tablets are enough. The tattoo feels like scratching on numb skin.
Will the nipple stay raised?
It flattens somewhat over the first year, which is why it is made taller than you might expect at first. If it loses too much height it can be redone or built up with a small filler graft. Skin over an implant tends to flatten more than skin on a flap.
Can both nipples be tattooed to match?
Yes. If both breasts were rebuilt, both nipples are made and tattooed in the same sessions. If one natural nipple remains, the new one is matched to it in position, size and colour, and the tattooist may lightly adjust the natural side so the pair look alike.
Can I shower and wear a bra afterwards?
Keep the dressing dry for the first few days, as instructed, and wear a soft bra without a seam or underwire over the nipple. A small protective shield is often given so nothing presses on it while it heals. Normal showering and bras return within a couple of weeks.
What can go wrong?
Small things, mostly. The tip can lose its blood supply and scab, the wound can open slightly, or the nipple can flatten more than hoped. Infection is uncommon and treated with antibiotics. If the skin is thin, the team may advise against surgery in the first place and suggest a tattoo instead.
How long does the tattoo last?
Medical tattoo pigment fades faster than ordinary tattoo ink, so expect a touch-up within a few years. Keeping the area out of strong sun slows the fading. A tattoo alone, without a surgical nipple, fades the same way and is refreshed the same way.
Is it covered by Aarogyasri or insurance?
Nipple reconstruction is often treated as part of breast reconstruction after cancer, but tattooing and stick-on nipples are sometimes excluded. Aarogyasri, CGHS, ECHS, EHS and cashless insurers each draw the line differently. Call the helpline with your card details and we will check before you book.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
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Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- American Cancer Society — Breast Reconstruction Surgery
- Macmillan Cancer Support — Breast reconstruction
- Cancer Research UK — Breast reconstruction
- NHS — Breast reconstruction
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Nipple TattooingThe colour step, and the tattoo-only optionSurgery on the Other Breast for SymmetryMatching the two sides before the nipple is placedSensation After Breast ReconstructionWhy a new nipple does not feelReconstruction After Radiation: What ChangesWhy irradiated skin changes the planBreast Reconstruction and Flap SurgeryEvery reconstruction page in one place
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