There is no nipple
After mastectomy, the breast is restored, but without the nipple and areola, or the breast is not restored.
State after mastectomy
CONDITION / BREAST
Absence or deformation of the nipple and areola.
Absence or deformation of the nipple and areola - when after mastectomy they are absent or they have shifted, flattened or faded. The nipple and areola are reconstructed at the end, when the shape of the new breast has stabilized: the nipple is formed from local tissues, the areola - with a medical tattoo.
CONCEPTUAL VISUALIZATION- What it is
- The nipple and areola are absent after mastectomy, or they are displaced, flattened, faded, or asymmetric.
- When restored
- Finally, several months after breast reconstruction, when its shape has stabilized.
- What
- The nipple is made of local tissues of the new breast, the areola is a medical tattoo.
- Is it necessary?
- No. Some women choose only a tattoo or leave their breasts without a nipple — it's your decision.
01 / WHAT IS ITWhy a nipple?
Why a nipple?
may not be
During a mastectomy, the surrounding skin and the nipple are often removed along with the breast. If the breast is reconstructed in the same operation, the surgeon can sometimes save the nipple and the skin - this is a nipple-sparing mastectomy. But it is not suitable for everyone: an international consensus of 44 surgeons named the oncological reasons why the nipple cannot be saved.
Then the breast is restored without the nipple, and the nipple and areola are made a separate stage. It often completes the reconstruction: it is the nipple and areola that transform the restored tissue volume into the breast.
It also happens that the nipple is there, but has changed. After a nipple-sparing mastectomy, it may shift or partially die due to poor blood supply. A previously restored nipple flattens over time, and the areola tattoo fades.
The woman herself decides whether to restore the nipple or not. In a survey of 191 women after reconstruction with their own tissue, those who had a nipple reconstruction rated breast satisfaction and sexual well-being higher. But in general, the quality of research on the benefits and risks of this operation is very low.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWith what
With what
apply
Most often — after a mastectomy, but the nipple and areola also change after other breast operations.
The nipple shifted
After nipple-sparing mastectomy or organ-sparing surgery, the nipple is higher, lower, or to the side of the desired place.
Breast deformation after lumpectomyThe nipple flattened
Over time, the restored nipple became lower and almost merged with the skin.
Areola pale
The areola tattoo has lost color or has become uneven.
Asymmetry
Nipples at different heights, areolas different in size or shape — in particular after breast reduction or lifting.
Complications after breast lift and reductionA scar on the nipple
After partial death of the nipple or areola, a scar remains or part of the nipple is missing.
03 / REASONSIt depends on what
It depends on what
nipple view
Oncological treatment and the method of reconstruction affect the position and shape of the nipple.
Type of mastectomy
Whether it is possible to save the nipple is decided by oncological indications. If it was removed, the nipple and areola are restored in a separate stage.
Blood supply
In a pooled analysis of 12,358 nipple-sparing mastectomies, partial or complete nipple death occurred in 5.9%.
Irradiation
In a series of 1037 nipple-sparing mastectomies, previous radiation was an independent factor in nipple displacement. In another observation (191 women), it was more often necessary to renew the areola tattoo after radiation.
Method of reconstruction
In the same series, nipple displacement was independently associated with reconstruction with own tissue and vertical incisions.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
An absent or long-deformed nipple is a planned situation: it usually does not require emergency care. But after a mastectomy, reconstruction, or any breast surgery, some symptoms require immediate care.
103 immediately if:
- suddenly it is very difficult to breathe;
- pain in the chest or upper back;
- the heart beats very fast;
- the person fainted;
- confusion, slurred speech;
- very frequent breathing;
- bluish, pale or mottled skin;
- very high or very low temperature, chills or shivering;
- a rash that does not go away when pressed.
Do not delay a visit to the doctor:
Immediately - to the surgeon who operated; if it is not possible to contact - to the reception department: bleeding from the wound; sudden or increasing pain or swelling in the area of the operation, the breasts quickly increase in size and become tight; after the operation, the nipple, skin or transplanted tissue darkened, turned blue or blackened; suddenly numb hand; cough with blood; pain and swelling in the calf or arm. On the same day, to the surgeon: the wound turned red, became hot, pus flows from it. In the coming days, the oncologist: the nipple began to retract, although it was not so before; a rash similar to eczema appeared on the nipple; discharge from the nipple, in particular with blood; a new lump in the breast or under the armpit. Planned: the nipple is missing, it has flattened, shifted, or the tattoo has faded.
05 / DIAGNOSTICSAs defined,
As defined,
what to restore
- Documents
A statement about the mastectomy and reconstruction, whether there was radiation or whether the treatment was completed.
- Review
The shape and position of the new breast, the quality of the skin, scars, the condition of the other breast and the nipple on it.
- Marking
Where should be the nipple and what size areola - so that the breast looks symmetrical.
- Coordination with the oncologist
Are there no further examinations or treatment needed, after which it is better to postpone this stage.
06 / TREATMENTHow to restore
How to restore
nipple and areola.
There are many ways to restore the nipple and areola. The method is selected according to the condition of the skin, whether there was radiation, and the wishes of the woman. The nipple and areola are often restored separately: first the nipple, then the tattoo.
01
nipple
Finally, when the shape of the breast has stabilized.
- Local patches
- The nipple is formed from the skin of the very new breast - this is the most often described method. In a review of 75 articles, complications after local flaps were in 7.9%, and after graft transplantation - in 46.9%.
- Loss of altitude
- Over time, the reconstructed nipple becomes 45–75% lower, although satisfaction was not significantly affected. Therefore, it is formed with a margin of 25–50%.
- Reinforcement
- To make the nipple flatten less, cartilage, fat, dermal matrix or synthetic material is placed under the flap. The height is thus preserved better, but the flap may die more often; synthetic materials gave more complications. The quality of this data is low.
- Part of the nipple from the second breast
- Sometimes part of a healthy nipple is transplanted to a new breast.
02
areola
- Medical tattoo
- Areola and nipple color are created by tattooing. In a review of 75 articles, complications after areola tattooing were in 1.6%, after skin grafting in place of the areola — in 10.1%. A systematic review of 18 studies of medical tattooing (areolas as well as scarring, vitiligo, baldness) showed high satisfaction, although the level of evidence was low.
- 3D tattoo
- Shadow and light create the effect of a voluminous nipple even without surgery. In the observation of 191 women, 62 had such a tattoo, there were no complications; 32% of them subsequently updated the tattoo, mostly because the color faded.
- After irradiation
- In the same observation, after irradiation, the tattoo had to be updated more often.
03
If the nipple is present, but deformed
- Displaced nipple
- In a series of 1037 nipple-sparing mastectomies, the position of the nipple was corrected in 77 cases (7.4%), each time later, with a separate intervention. Most often — by excision of a sickle-shaped strip of skin near the areola.
- After the death of the nipple
- If the nipple is partially or completely dead, after healing, it can be restored in the same ways as the one that is missing.
04
What the research says
- satisfaction
- In a review of 59 articles, an average of 81.9% of women were satisfied with the appearance of the restored nipple, 80.3% were satisfied with the symmetry; 89.5% would do it again.
- Saved or restored
- According to a meta-analysis of 23 studies, satisfaction with a preserved nipple was higher (80.5%) than with a reconstructed local flap (73.9%).
- Save the nipple
- According to a meta-analysis of 13 studies (3895 women), after nipple-sparing mastectomy sexual and psychosocial well-being was higher than after mastectomy with nipple removal, and the rate of complications did not differ. But you can save the nipple only when it is oncologically safe.
- Limits of evidence
- A systematic review of 37 studies rated the quality of evidence about the risks and benefits of this operation as very low.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
The nipple and areola are restored at Dr. Valikhnovskyi's Institute of Surgery in the direction of "Breast Reconstruction" — as the final stage of breast reconstruction, a few months after the main surgery. Oncological supervision continues to be conducted by an oncologist.
CLINIC SERVICE
Breast reconstruction
Breasts after mastectomy - with own tissues, implants or fat, immediately or later.
View service
What we do for this condition
- Nipple from local fabrics — the nipple is formed from scraps of the skin of the new breast with a margin of a quarter to a half, because over time it loses a significant part of its height.
- Areola tattoo — an artistic medical tattoo creates an areola with a volume effect; color fades over time, so tattoos are often updated.
- Stages together — symmetrization of the second breast, lipofilling and nipple are planned a few months after the main operation, when the shape of the breast is stabilized.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a picture of your breasts and a statement about your mastectomy and reconstruction.
- ConsultationExamination of the new and second breast, assessment of skin and scars, discussion of your wishes.
- PlanNipple, tattoo or both; whether shape or symmetry correction is needed first.
- Restoration of the nippleThe nipple is formed from local tissues; Areola tattooing is a separate stage after healing.
- Maintenance and inspectionsInspections; tattoos are updated as needed when the color fades.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
When can the nipple be restored?
Finally, several months after breast reconstruction, when its shape has stabilized. If the treatment is still ongoing, the terms are agreed with the oncologist.
Why does the restored nipple flatten?
The tissues contract over time and the nipple loses 45-75% of its height. Therefore, it is formed with a margin of 25–50%. This loss did not significantly affect women's satisfaction.
Can you get by with just a tattoo?
Yes. A volume tattoo creates the appearance of a nipple without surgery. In a survey of 191 women after reconstruction with their own tissues, among those who restored the nipple, tattoos were chosen most often - 58%.
How long does a tattoo last?
The color fades over time. In a study of 62 women with a 3D tattoo, 32% subsequently updated it, more often after radiation.
Can a misplaced nipple be corrected?
Yes. After a nipple-sparing mastectomy, the displacement is corrected with a separate operation, most often by excision of a strip of skin near the areola. What is possible for you, the doctor will tell after the examination.
The nipple began to retract. What to do?
If it wasn't like that before, show it to the oncologist in the next few days. Likewise, a rash on the nipple, similar to eczema, or discharge from it.
Is it necessary to restore the nipple?
No. It's your decision: someone chooses surgery, someone just a tattoo, and someone leaves their breasts without a nipple.
Sources
16 sources · consensus, systematic reviews, meta-analyses, cohorts and the NHSshowCollapse
- Nipple-areola complex reconstruction techniques: A literature reviewEuropean Journal of Surgical Oncology, 2016doi:10.1016/j.ejso.2016.01.003 ↗
- Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysisGland Surgery, 2017doi:10.21037/gs.2016.08.01 ↗
- A systematic review of risks and benefits with nipple-areola-reconstructionJournal of Plastic Surgery and Hand Surgery, 2017doi:10.1080/2000656X.2016.1251935 ↗
- Patient-reported outcomes for nipple reconstruction: Review of literatureThe Surgeon, 2021doi:10.1016/j.surge.2020.11.005 ↗
- Patient Satisfaction Increases with Nipple Reconstruction following Autologous Breast ReconstructionPlastic & Reconstructive Surgery, 2021doi:10.1097/PRS.0000000000008180 ↗
- A Systematic Review of Comparison of Autologous, Allogeneic, and Synthetic Augmentation Grafts in Nipple ReconstructionPlastic and Reconstructive Surgery, 2016doi:10.1097/PRS.0000000000001861 ↗
- 3D Nipple-Areolar Tattoo: It’s Technique, Outcomes, and UtilizationAesthetic Plastic Surgery, 2021doi:10.1007/s00266-020-01967-w ↗
- Applications of Medical Tattooing: A Systematic Review of Patient Satisfaction Outcomes and Emerging TrendsAesthetic Surgery Journal Open Forum, 2021doi:10.1093/asjof/ojab015 ↗
- Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomyBreast Cancer Research and Treatment, 2018doi:10.1007/s10549-018-4937-1 ↗
- The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 ProceduresArchives of Plastic Surgery, 2016doi:10.5999/aps.2016.43.4.328 ↗
- Quality of Life and Complications after Nipple- versus Skin-Sparing Mastectomy followed by Immediate Breast Reconstruction: A Systematic Review and Meta-AnalysisPlastic & Reconstructive Surgery, 2023doi:10.1097/PRS.0000000000010155 ↗
- Nipple-Areola Complex Malposition in Nipple-Sparing Mastectomy: A Review of Risk Factors and Corrective Techniques from Greater than 1000 ReconstructionsPlastic & Reconstructive Surgery, 2017doi:10.1097/PRS.0000000000003507 ↗
- MastectomyNHS, 2025nhs.uk/tests-and-treatments/mastectomy ↗
- Symptoms of breast cancer in womenNHS, 2024nhs.uk/conditions/breast-cancer-in-women/symptoms-of-breast-cancer-in-women ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
The figures on the page are from these sources.
Want to restore
nipple and areola?
Send a photo of the breasts and a statement about the operations. The doctor will tell you what can be done and when.