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Do nipples matter?

Supplied to women by Mother Nature to help them nourish their young (and weirdly, provided to men too), nipples might be something we take for granted, but a breast can look lonely without one. We asked readers whether nipples really are the ‘cherry on the cake’! 

When you lose a breast, you will almost certainly choose to wear a breast form or have reconstruction. Both will give you an outline that belies the fact that you’ve had surgery. But what you may also have lost is your nipple. And, while it can be embarrassing when you enter a cold room wearing a close-fitting top and some clever clod quips that it’s rude to point, most women prefer to restore a nipple outline after surgery.There are several routes you can take to achieve this, from custom silicone nipples to medical tattooing and from skin transplants to Amoena’s own self-adhesive nipples.

Make me a new one

The trend in breast cancer treatment these days is definitely towards either breast-conserving surgery (lumpectomy) with immediate reconstruction, or, if a full mastectomy is needed, again to provide immediate reconstruction. More and more women, therefore, are waking up from surgery with a reconstructed breast, which many believe helps them cope with the emotional impact of breast cancer: they feel more ‘womanly’ with two breasts and can focus on getting their lives back to normal, whereas a mastectomy without reconstruction would be a constant reminder that they have had cancer. Other women have a reconstructive procedure some time after their mastectomy. But why go on to restore a nipple?

Body image is a sensitive issue and sometimes our insistence on ‘perfection’ can be somewhat irrational (and almost incomprehensible to our long suffering partners). For example, a woman will go through a lot to recreate the breast or breasts she has lost to cancer, even though the world will probably never see them. And when some women have gone through hours of reconstructive surgery, sometimes having flesh removed from other parts of their body and ending up with not just one scar site but several, they often feel that the breast mounds they are left with are somehow naked without the nipple. Cliché it may be, but many use the phrase ‘It’s the cherry on the cake,’ and aren't satisfied until it is back in place.

I feel like a woman

Nipples come in all shapes and sizes. Some women do not have prominent nipples anyway, so they don’t feel it necessary to either have one reconstructed or wear a prosthetic nipple to avoid looking lop-sided on a cold day. Others are not so much bothered about the effect when clothed, but simply want to look as good as they can ‘for themselves’. For them, it’s about going from an almost androgynous chest appearance to having two womanly breasts again. 

So what are the options? The first is nipple reconstruction, where your surgeon will create a new nipple shape, either by cutting into the reconstructed breast and leaving it to scar over and form a raised area that mimics an areola, which will then be tattooed, or by grafting some skin from an area like your inner thigh, which is slightly darker in appearance anyway, onto your reconstructed breast. This might also be tattooed in due course to color-match with your other nipple.

Sarah Henson had immediate reconstruction following her radical mastectomy. In a ten-hour TRAM-flap operation (or transverse rectus abdominis myocutaneous flap) procedure, Sarah’s breast tissue was removed and muscle and skin was taken from her abdomen to create a new breast shape. “They took veins from my legs for the blood supply. They then have to crack your ribs to set up the supply and do the mastectomy through the nipple. I opted for this procedure because I didn’t want anything artificial [i.e. a silicone implant].” 

Before her procedure, Sarah’s surgeon had talked to her about creating a new nipple once her new breast had healed and settled down. She wanted to know her options but found it difficult to get any details. “I was desperately seeking information on the internet – something like this article actually! I wanted to know what it was going to look like and what was going to happen. You can’t picture it in your head. I asked at the hospital if I could see any pictures but they just said ‘It will be fine’. There is very little information available, which is why I like to tell other women about it if they want to know,” explained Sarah. 

When she decided to go back for a new nipple, a lot of her friends and family asked why. “They were surprised I was going back for more – I’d been through so much, but it is about feeling whole and coming to terms with what you have had done. 

Psychologically it has boosted me. You feel really self-conscious sometimes, and when I didn’t have a nipple I felt odd. People would stare – for example in changing rooms. It was a bit like when I lost my hair.” She did consider prosthetic nipples but, she confessed: “To me, anything ‘extra’ is just a nuisance."

Sarah’s nipple reconstruction procedure involved a skin graft from her inner thigh. “They stitched it onto my reconstructed breast, then twisted it and clamped it to make a nipple shape. At first it was far too large and I was worried that it would stay that way, but it did settle down and it has gradually shrunk in size so it’s a great match for my existing nipple now."

After the operation, Sarah could not have been more pleased: “I am so grateful for all the professionalism I received. It has helped me get better and I just can’t thank people enough – all the surgeons and nurses, all the staff at the hospital.” 

Delighted with the result, she said: “It’s like putting a dot at the end of the line. I am over this; I have got through breast cancer. That’s how it has made me feel.”

Sarah’s advice to other women is to find out as much as possible about their options beforehand. “It was quite alarming to discover how little information is out there. Just keep on digging, don’t take no for an answer. And never be afraid to ask for a second opinion.” 

Designs on you 

Pat Bussy had a mastectomy with immediate LAT flap and expander reconstruction five years ago this November. She found the whole process rather overwhelming and, because decisions had to be made so quickly, quite confusing: “My surgeon went into the details of the mastectomy so thoroughly and I was in such a state of shock that I had breast cancer, I just wanted the cancer gone. He showed me lots of photos of reconstruction and I thought ‘I don’t even know if I can make a decision about this’. I remember he said ‘You should have a reconstruction, you are still young,’ although I don’t think we discussed nipples at that stage.”

Pat was extremely pleased with her reconstruction, although after about six months, when her surgeon asked whether she would like a new nipple, she told him she did not want any more surgery. “I had already had to have my implant replaced, which meant a second procedure, and I said ‘No, enough is enough.’ He then asked whether I had thought about stick-on nipples. I didn’t even know they existed.”

Pat’s surgeon referred her to a prosthetics consultant who makes custom nipples. “He explained everything very nicely and said ‘We can either make a nipple from scratch or make a mold from your existing nipple.’ We decided to use my existing nipple as the template, so he went ahead and took the mold and then about two weeks later my new nipples were ready. He makes five at a time – which I thought quite bizarre. I asked him why and he said: ‘Well you never know, you might lose one in the fitting room!’ Now, whenever I am in a changing room I always have a final look round before I leave to check that I haven’t left my nipple behind! He told me they would last for eight or nine years if I wear them all the time.” 

Pat sticks her nipple on with special glue and it will usually stay on for about three months. She is pleased with her decision: “I didn’t think I wanted another nipple but you feel very whole again when you wear them. It’s completely painless, too, which is another bonus after so much surgery.”

After wondering whether she could be bothered with a new nipple, Pat admits that she does feel more relaxed now in situations like swimming pool changing rooms or if she’s ever lucky enough to visit a spa. “I was always very self-conscious, but now it makes you feel like everybody else and you don’t get looked at.” 

Sticking around 

Like Pat, Barbara Heard decided she did not want further surgery following her mastectomy with immediate reconstruction in 2005. When she subsequently had to have her implant changed, her surgeon suggested that she could have a new nipple created but she felt that a skin graft was an operation too far and, instead, she carried on using self-adhesive nipples. 

Amoena’s range of self-adhesive nipples features a very soft silicone for the most natural look and feel, a slightly firmer areola that is visible through the material of most bras, and a range of colors and sizes. Incorporating the clever, non-sticky, self-adhesive technology used in Amoena’s Contract breast forms, they adhere directly to the skin, and are intended to be removed at the end of each day.

Barbara's report? The adhesion is excellent. “They do stay on well. When I got my first set I didn’t realize they were meant to be removed at the end of the day and put on again in the morning. They tend to fall off when you have a shower though!” Did she find the new nipples easy to care for? “They are very easy to use – no trouble at all. They come with a cleanser that prepares both your skin and the adhesive surface. As long as you keep everything clean, there’s never any worry that it won’t stick.” 

Will she carry on using the new Amoena nipples? “Yes, I would like to continue with them because I am fairly big boobed and if it is cold, it’s obvious that I only have one nipple. I would normally put a nipple on when I get dressed in the morning and then I’d forget about it for the rest of the day. I must say the shape is great – you do feel confident when you wear them. I’m not sorry that I didn’t go ahead with nipple reconstruction – personally I think stick-on nipples are much more convenient. I have not seen a reconstructed one but I have heard that the result isn’t always good. I remember going into a changing room with my friend and when she saw my reconstructed breast and I told her I was wearing a self-adhesive nipple, her eyes nearly popped out of her head. She didn’t know it wasn’t real!” 

Amoena’s sales director, Loretta Pitt, has heard similar comments from many women. “Lots of our customers tell us they don’t want to put themselves through yet more surgery, but they really love the look they get from our self-adhesive nipples,” she said. “They are so versatile – they can be adhered to a breast form for a very realistic outline, as well as to a reconstructed breast. But they have other uses, too. Sometimes radiotherapy can change the appearance of a natural nipple, and because they are slightly recessed at the back they can be stuck over your own nipple to help achieve a balanced look by ensuring both breasts are identical.” 

What’s your dream topping? 

So although we might take them for granted while we still have two, nipples can become a bit of a holy grail when breast cancer deprives us of one – or both. However you decide to replace yours, we hope this article has helped you to consider your options. Thankfully, there are so many possibilities these days that it’s much more likely you’ll arrive at a solution that suits you.