Reconstructing the nipple is a fairly simple, straightforward procedure. If done on its own it is usually done under local anaesthetic and the patient goes home on the same day. Nipple reconstruction is often done at the same time as other necessary surgery; for example breast matching surgery, reshaping of the reconstruction, revision of any dog ears.

The reconstructed nipple usually looks a little different from the opposite nipple, it lacks any sensation and it does not become erect in the cold. However, it is a popular procedure which completes the breast reconstruction procedure and can be viewed as being the ‘cherry on the cake!’.

There are a number of ways of making a new nipple .

• Cv flaps: a small piece of skin and fat is lifted and folded on itself to create a ‘nipple’. This leaves small scars on the breast mound where the skin and fat was lifted from. Nipples created this way tend to shrink and flatten so initially the nipple is made larger than the normal nipple.
• Nipple share: this is a good option if the other nipple is very large. Half of the large nipple is removed and transferred to the reconstructed breast mound. This creates the most realistic nipple. Importantly, the sensation of the ‘donor’ nipple is not significantly affected.
• Areolar grafts: the normal areola tends to be very slightly raised above the level of the breast skin. This can be imitated by placing a thin skin graft on the breast mound around the nipple. The skin is usually taken from the inner, upper thigh or, if other surgery is being performed simultaneously (eg breast reduction, dog ear reduction) spare skin can be used from these other procedures.
• Tattooing: this is a very simple method for recreating the colour of the nipple and areola. Numbing cream is applied to the nipple and then tattoo pigment is driven into the skin with fine needles. The procedure is usually painless, and you can go home on the same day. [See postop advice ]