Areola and Nipple Tattoos and Reconstruction

April 10, 2025

This page was reviewed under our medical and editorial policy by Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

During a mastectomy to treat breast cancer, one or both nipples may be removed, along with the entire breast or both breasts. Some patients may choose to restore the nipple and the dark-colored skin surrounding it (the areola) as part of the final step of the breast reconstruction process.

Nipple reconstruction is a surgical procedure to restore the nipple and sometimes the areola. Nipple tattooing may also help restore a patient’s confidence and post surgery appearance, creating a realistic-looking nipple — in shape, size and color — and/or the areola. Decisions about each phase of breast reconstruction are very personal and based on patient preference.

This guide to nipple tattoos and nipple reconstruction procedures is designed to help patients decide which option best suits their needs and preferences.

Nipple Reconstruction Surgery

During nipple reconstruction surgery, a new nipple is created using small pieces of the patient’s own skin. It may come from the reconstructed breast or from the patient’s groin, thigh or abdomen.

In most cases, the patient’s skin on the new breast is cut and folded using a special technique, and shaped into a nipple. If skin is needed from another area of the body, it is cut from the area, shaped and stitched into a nipple form, and surgically attached where the original nipple was once located. The procedure is often performed in an outpatient or clinic setting. Local anesthesia or sedation is used so that patients feel comfortable and pain is blocked.

There are many ways to create an areola. Tattoo ink may be used to create an areola around the new nipple four to six months after nipple surgery, using color and shading to make it look as realistic as possible. For some patients, skin grafts may be used to create the areola, along with the nipple, during nipple reconstruction surgery.

One advantage of nipple reconstruction surgery is that it uses the patient’s skin to recreate the nipple, making it 3D and very realistic, helping to restore natural color and shape. But some patients may not feel up to surgery after finishing breast cancer treatment and reconstruction, and every medical procedure has potential risks and side effects. While nipple reconstruction has a positive physical outcome for many patients, milk production and sensation are not restored.

Patients undergoing radiation therapy for breast cancer may need to delay their surgery until their treatment has finished, as they are at a higher risk of infection after surgery. Doctors often urge patients who smoke to postpone reconstruction until they have been tobacco-free for at least two months.

Whether or not to have nipple reconstruction surgery is a big decision, but there is no rush to decide. Surgery may wait until the patient feels ready. Those who are unsure may wish to speak to their medical team or a local support group for advice and guidance.

Complications and Risks of Surgery

Nipple reconstruction is considered a safe and well-tolerated outpatient procedure, but there is always a risk of side effects. These may include:

• Infection
• Wound separation
• Nipple loss due to tissue death (necrosis)
• New nipple does not match the other breast (asymmetry)
• The cosmetic look is not as expected

What to Expect

Nipple reconstruction is performed by an experienced plastic surgeon who will go over what a patient may expect and how to prepare. The goals of surgery and how the nipple or both nipples may look, and/or match the other breast, are discussed with each patient. Patients may help mark the position for the new nipple before the procedure.

The surgery is usually performed as an outpatient or in-office procedure and takes about 15 minutes, although it may be longer. Patients may wish to wear loose-fitting tops so they will feel more comfortable after the procedure.

After surgery, it is important to rest and keep the wound clean using bandages and antibiotic medication for about two weeks. Patients who experience any pain or discomfort should call their doctor right away.

3D Nipple Tattoos

Nipple tattooing uses tattoo ink to create a nipple following a mastectomy. This procedure may be combined with nipple and areola reconstruction, or it may be performed without.

Using needles and various shades of ink, the plastic surgeon or medical tattooist creates a realistic-looking nipple and/or areola. Different colors of pigmentation may be combined to create a 3D and realistic appearance.

Tattooing without surgery is an option for those who want to avoid another medical procedure or for patients who are unable to have surgical nipple reconstruction due to tissue damage from radiation. Researchers in Plastic and Reconstructive Surgery note that nipple tattooing has shown a lower complication rate than skin-graft nipple reconstruction surgery.

However, tattoos may not suit a patient who would prefer a raised nipple. Although 3D nipple tattoos may look realistic, they are not raised from the skin.

Complications and Risks of 3D Nipple Tattoos

Some side effects are possible after nipple tattooing. These may include:

• Allergic skin reaction to the tattoo
• Swelling, redness or temporary discomfort
• Infection
• Fading and the need for repeat tattoo
• Mismatch color with the other breast nipple
• Not satisfied with the cosmetic outcome

Very rare complications may include:

• Tissue death around the nipple and areola
• Extreme skin sensitivity

What to Expect

Nipple tattooing is an outpatient procedure that may be performed in a clinic or doctor’s office. Before the process begins, the tattoo specialist will talk to the patient about placement, ensuring the correct area is tattooed.

Patients may be asked to take antibiotics the week leading up to the appointment to help prevent infection. No lotions or creams should be used the day of the procedure.

Local or topical anesthetic is administered before the procedure to reduce discomfort. The procedure takes about 90 minutes. After the tattoo is complete, patients may be asked to disinfect the site or keep a waterproof dressing on for four days. After four days, lotions may be applied to aid in healing, as instructed by the care team. Patients are asked to limit exercise, swimming and lifting for up to two weeks.

Prosthetic Nipples

Nipple prosthetics are silicone devices that resemble real nipples in shape and size. They are attached with a special adhesive or tape and may be used or removed whenever the patient likes. They may be obtained from a specialty shop or may be custom-made.

In some cases, internal nipple prosthetics may be surgically inserted, but this procedure has a higher risk of complications compared to other nipple reconstruction options.

Using external nipple prosthetics is simple and convenient, making them an option for patients who want to avoid additional surgery or tattooing. But because they are not permanent, they may not be a long-term solution for some patients. A prosthesis does not have the feel of real skin.

Complications and Risks of Prosthetic Nipples

The risk of complications from external nipple prosthetics is low. It is possible the patient may not be satisfied with their appearance or may have difficulty positioning them correctly. Some patients may develop skin irritation or allergic reactions to the adhesive or medical tape used to attach the prostheses to the body.

What to Expect

Patients considering nipple prosthetics may wish to speak to their doctor or plastic surgeon for advice. They may also assist with custom-made prosthetics.

When deciding on prosthetics versus a surgical option, patients should consider whether they would prefer a removable option, or something more permanent, like a tattoo.

Patients should always check with their health insurance regarding coverage. For many patients, policies cover costs associated with mastectomy recovery, including reconstruction and external prostheses.