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Nipple Reconstruction – The Decision & Procedure

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Trying to decide whether or not to get nipple reconstruction was one of the hardest decisions I have had to make since my diagnosis. Funny really, since it is the most insignificant of all the surgeries I have had. But I think that is exactly why!

It was so much easier to decide to have a bilateral mastectomy. There were clear reasons, most of which came back to ridding myself of cancer and doing all I could to ensure it didn’t come back in the future. But nipples don’t really serve any purpose – at least not outside of breastfeeding, and that would not be happening even if I did have boobs and no cancer!

It is possible to have the nipples preserved during mastectomy, but it depends on the type of cancer, where it’s located, how aggressive it is, the surgeon’s preferences, and your own acceptable level of risk. They do contain breast tissue, so there is always a chance that the cancer can come back there. For me this was the major concern, so I was happy to have my nipples removed.

One of the downsides to keeping your nipples is that there is a risk that the blood supply is compromised during the surgery, they develop necrosis and die, so have to be removed anyway. They will also never have any feeling in them, as all of the nerves connecting them will be severed during the mastectomy. (Although this may change in the future. I have seen that there are a handful of surgeons, mostly in the US, doing a new type of surgery where the nerves are reconnected. Results are still somewhat mixed, but there is progress!)

I was a little sad about it, but once my nipples were gone, I can honestly I didn’t miss them at all. I kinda liked my nice smooth boobs. So why then, would I put myself through another surgery to get nipple reconstruction?

Well, that was the question I kept asking myself too! Reconstructed nipples are nothing like the real thing. They are just a nub of skin to give the shape of a nipple. There is no areola, no colouring and no sensation. They can sometimes be permanently erect and showing through clothes. There is a good chance they will go flat over the years, and either need redoing or accepting they are flat. So why would I do this?

It seems like a bit of a cop out to say “because my husband wanted me to!”. I did ask his opinion, and he did vote for nipples, but I honestly don’t think he totally gets that they won’t be the same, even though I’ve told him! His opinion was definitely a consideration though.

I also thought about what my surgeon said. I have had such a great reconstruction, and many other women have told him that the nipples just made them feel “finished”.

And then there was that tiny voice at the back of my head saying “so yes, you like your boobs without nipples, but what if you really love them when you have nipples again?” I did test out some temporary nipples (you can see what I though of them here) to help me decide one way or the other.

As usual I did as much reading as I could on line too, learning from the stories of others, both patients and medical professionals. I even watched the procedure to know exactly what I was in for. (If you want to see for yourself, this is the video I watched. Be warned, it’s a graphic medical procedure! There are some others on YouTube too.)

Another consideration was that surgery is relatively easy for me. I do not have any issues with the anaesthetic, I have not had any real pain from my previous surgeries, and I seem to recover quickly and easily with no complications. If further surgery scared me, I likely would have thought about this a lot.

About a month ago I fronted up to my surgeon’s office and said “lets do this!”

During that appointment my surgery got a little more complicated. As my implants have settled, it had become even more obvious that my left side was smaller than my right. It was really not too bad though, and if I wasn’t already going back for another op, I would not have given it a second thought. My surgeon though suggested that while we were there we could replace the implant with one 50ml larger, and it would even me up a bit more.

Right before I went off to theatre. It’s hard to see the difference in size from this angle

So two days ago I made my way into hospital to get my left implant replaced, and bilateral nipple reconstruction.

The hospital visit is all becoming routine now, and this time everything again went like clockwork. My surgery was scheduled for 2pm and took about an hour. I was soon back in my room, eating everything in sight and counting down the minutes until I could go home – which was of course the next morning. My surgeon always likes us to stay in overnight.

Before my surgery one of the breast care nurses came to see me and she asked if I was having a drain put in. My reaction was “What??!!” I hadn’t even considered that I might have a drain in again. I checked as soon as I woke up, and luckily did not find a drain. Relief!

I also checked my dressings immediately. I couldn’t see a thing, but I again noticed I did not have the waterproof covering over them. That didn’t worry me too much, as my exchange surgery was the same, but when I asked for the waterproof dressings the next morning, my surgeon agreed they could be put on. Unfortunately this time he said no, so I’ve now got two weeks without a proper shower – until I go and get these dressings off!

Nipple Reconstruction
Right after I came back to my room. The black spots are not blood, but rather the holes in the gauze where my new nipples are sitting. My left side is now sitting higher – it will take time to settle into place like all implants do

I don’t feel any sensation at all at the site of the nipple reconstruction – but I did not expect to since I have no feeling there anyway. The incision from the implant replacement uses the same scar as my previous surgeries and is to the side, mostly towards my armpit. While I’m sitting still, I have no feeling here at all. I feel a little pulling, kind of like if I had a decent bruise, when I move my arm, but apart from that I’m in no discomfort at all.

As for restrictions, the breast care nurse did say I need to again not reach for anything with my left arm, raise it above my shoulder, or to lift anything heavier than 2kg. I didn’t ask how long for, but I will check with my surgeon at my two week appointment. It really feels like overkill if I have to be careful again for six weeks.

One of the big questions I had was which bra I would need to wear after the surgery. It was a bit of a dilemma since the relacement of the implant dictated I should continue to wear the super tight post-surgical bra I’ve been wearing since my exchange surgery, but this would put extra pressure on the nipples and flatten them. So my surgeon recommended going back to the softer bra I wore right after my bilateral mastectomy.

Not being able to see anything but dressings also means I cannot see the results of my nipple reconstruction – I will report back in two weeks after the big reveal!

Edited to add – see the big reveal here!

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