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Once a reconstructed breast has settled into its final position (about three or four months after flap revision surgery or implant exchange surgery), new nipples can be recreated. For many women, adding nipples to their reconstructed breasts brings a sense of closure to the breast cancer experience. But this is an optional procedure; because reconstructed nipples remain erect, and do not react to cold or touch the way normal nipples do, some women forego this part of reconstruction.
Nipple reconstruction is an art, creating nipples that look exactly like the real thing. Most surgeons recreate nipples using skin of the new breast: a small flap of skin is freed on the front of the breast, fashioned into a nipple and sutured in place. Because reconstructed nipples tend to shrink, they are initially made up to 50% larger than the desired size. Another, more traditional procedure uses skin grafts to create the nipple and areola. Small pieces of skin are taken from the inner thigh, labia, or back of the ear (the skin in these areas tends to be darker) and are grafted onto the breast. These techniques tend to scar an additional part of the body, however, some surgeons prefer this type of nipple reconstruction.
Once the nipple is created, the area surrounding it is tattooed to simulate the areola. Your surgeon may perform the tattooing in his office, or he may have a specially-trained technician do the tattooing. Some surgeons refer their patients to professional tattoo artists who are experienced with reconstructive tattooing. Because a reconstructed breast has little or no sensation, most women feel the tattooing more as pressure than pain. There are a wide variety of pigments to choose from; sometimes one or more are combined to produce the desired result. Tattoos often fade in time and must be redone.
"3D nipple tattooing" refers to a special process where different pigments are used to create the 3-dimensional look of a natural areola.