Frequently Asked Questions:

Will I have Sensation in my Reconstructed Breasts?

 While so much emphasis is placed on how reconstructed breasts look, little is written about how they feel — and we don’t mean how they feel to someone else. Rather, how will it feel to have our reconstructed breast(s) touched or how it will feel to us when we are embraced? The short answer is that there is no way to predict how much breast sensation any particular woman will retain or regain. Results are extremely variable.

 Mastectomy surgery disconnects the nerves, along with the other tissue. Skin-sparing procedures may preserve some of the touch sensation, regardless of whether there is an implant beneath your chest muscle and skin, or you choose to use your own tissue in a flap procedure. 

 Another type of sensation is deep touch. This is the pressure you feel against your chest wall when you are hugged. Since fat is softer and may transmit pressure easier, some reconstructive surgeons think reconstruction using your own fat might increase the sensation of deep touch.

 Regardless of the reconstruction procedure you choose, however, you will probably experience significant numbness of the breasts, and if you choose flap reconstruction, there will be numbness at the donor site as well. This numbness may lessen greatly over time with continued improvement even years after surgery. Unfortunately, in some women, the numbness never improves to any significant degree.

 In your breasts, the pattern of nerve regeneration, if and when it occurs, is that feeling returns first to the outside edges and moves inward toward the nipple area over time, though the nipples themselves will never regain the type of sensation they had before, even if your skin-sparing mastectomy was also nipple-sparing. Regarding the donor site, again the sensation farther out from the incision returns first, with feeling returning last in the area closest to the site.

 There are some reconstructive surgeons attempting to reattach severed nerves during reconstruction in order to restore breast sensation. The results are, unfortunately, questionable. The network of nerves in the breast looks like a river with many branches heading in myriad directions. Which nerve ultimately connects to which area of the breast is extremely complicated and almost impossible to ascertain. Many women will experience spontaneous nerve regeneration as part of the body’s own healing process, making it difficult to determine if the return of sensation was actually due to the surgeon’s efforts or would have happened on its own.

 As your body heals following reconstruction, you may begin noticing strange zings and prickly feelings in your breasts and donor sites. These are good signs. They show your nerves are functioning and are likely in the regenerative mode.

 What About my Nipples?

 Many women find the prospect of losing their nipples as upsetting as losing their breasts. They wake up from a biopsy or lumpectomy wondering if their nipple was part of what had to be removed, but are afraid to ask. And if they’re having a mastectomy and breast reconstruction, they wonder if the reconstruction will include the nipple and, if so, what it will look like. There are also women for whom nipples are not much of a concern, and whose only focus is on retaining or restoring the breast mounds so they look good in clothes. Like so much else regarding women’s emotional experiences on this breast cancer journey, almost anything and everything is normal.

 What About Nipple-sparing Mastectomy?

Along with so many other aspects of breast reconstruction, nipple reconstruction has advanced, as well. One of the most exciting developments in this area is mastectomy that spares the nipples altogether. But, again, too few surgeons are knowledgeable or experienced. Many more eschew the concept altogether, at worst dismissing it as risky and even dangerous. But there have been no reports in the scientific literature of cancer starting in the nipples, and studies seem to indicate the structure of the milk ducts in the nipple is unlike that of the smaller ducts and lobes in the rest of the breast, where most  breast cancers start.

 Admittedly, this is relatively new terrain with too few studies to make any firm judgments. But surgeons doing the most work in this area have a strong basis for believing the risk is minimal in appropriate situations. Research has examined cancer incidence in nipples after their removal in conjunction with mastectomy for breast cancer. Certain circumstances have been identified that may increase the risk of cancer cells being present: if the cancer is located less than 2 – 4 cm (about 3/4 – 1 1/2 inch) from the nipple; if the cancer is larger than 3-4 cm. (about 1 1/4 to 1 1/2 inch); lymph node involvement; and cancer in more than 1 quadrant of the breast. These parameters need to be part of the equation in considering nipple-sparing mastectomy.

 But again, and unfortunately, even if you are able to have your nipples saved, the sensation will never be what it once was, and they will most likely have no feeling. The nerves to them have been disconnected by the mastectomy, and much of the internal core of the nipple is removed. A few women’s nipples continue to become erect with the cold, however.

 The structure within the nipple, as well as the structures leading to it–such as the milk ducts–will be gone. Because the nipple no longer has anything to hold it up, it will likely lose much of its projection. Expect it to feel softer and less substantive than before. If this is something that bothers you, however, it is also possible to plump up your nipples with injected fillers.

 How are Nipples Reconstructed?

 There are many nipple reconstruction techniques, and surgeons often have their own special twists. Most nipple reconstructions these days use skin that is partially excised from the reconstructed breast and folded in various ways not unlike origami. The center remains attached and the raised skin and fat around it is folded, wrapped, and sewn together to create the new nipple. There are various methods with names like star flaps and skate flaps.

 Nipple reconstruction typically does not take place during the initial surgery when the breast mound is re-established, but during a second surgery where more of the cosmetic details are addressed. While your new nipples are healing, you’ll get to sport a nipple protector that may inspire you to perform Madonna ballads in front of your bathroom mirror.

Your healed nipple will be pale. If you want color, the nipple and areola areas can be tattooed to any shade you desire. The red pigment in your chosen shade tends to fade over time, however, so you may want periodic touch-ups. Don’t worry too much about pain from the tattoo needle, since your new nipple will likely be numb. Touch-ups may be a bit more uncomfortable, but you can interpret that as good, since it signals nerve regeneration.

 What if I Don’t Want to Fuss with Nipple Reconstruction, but I want Something?

 Some women, who initially thought they didn’t care about having nipples, change their mind after time has passed. One can always revisit the surgical reconstruction route. Or, there are lots of other alternatives available. Like rubber stick-on nipples, stick-on nipple tattoos, and actual nipple tattoos – including 3-D ones that look incredibly life-like. After you go for a while without a nipple, and then get one back, you’ll be amazed at how much of a difference it makes in how complete your breasts will look – just like a sundae with a cherry on top!

 Which Surgeons Should I Choose?

 Surgical oncologists are specially trained in removing cancerous tissues, although your lumpectomy or mastectomy surgery may be performed by a breast surgeon or general surgeon. If you’re planning on breast reconstruction, the surgeon removing the cancer should work in cooperation with the reconstructive surgeon (also called a plastic surgeon whom you choose for your procedure. If there is a breast diagnostic center in your area, it may have a list of surgeons and will schedule consultations for you. 

 After you select one or more preferred methods of reconstruction, seek the opinions of several surgeons certified by the American Board of Plastic Surgery who have extensive experience in those procedures. Not only will you increase the probability you will have successful results, but you will also reduce the likelihood they may discourage you from your choice or mistakenly believe you are not a candidate for that procedure. Ask about their success rate and how many of the procedures they have performed. Highly experienced doctors who specialize in the reconstruction you want will give you the best evaluation of your unique situation.

 Be assertive. Ask all the questions you need to ask in order to make an informed opinion. Many people feel intimidated by doctors and are hesitant to ask too many questions. If you’re a person who feels this way, you need to get over it now. Make a list of questions beforehand, bring someone with you and give them a copy of your list. This person can help you if your courage flags or if you feel overwhelmed, as well as provide another pair of ears and another brain to process what you’re being told. Write down the answers to your questions and check off each question only after you are satisfied with the response.

 Ask to view before and after photos of the surgeons’ work. Since these photos are usually taken within a few months of surgery, be aware that scars and areola tattoos will appear much more prominent than they will be after more time has passed. Instead, focus on the shape of the breasts, symmetry, and the artistry of the surgeon.

 Ask for patient references. Many women are happy to talk to others about what to expect and may even offer to show you their results in person. The most experienced surgeons usually have patients who volunteer to mentor newly-diagnosed women as a way to give back after successful treatment and reconstruction.

 Breast reconstruction is not the same as breast augmentation and requires a much higher degree of experience to obtain the very best outcome. If you are going to go through two or more surgeries to have breast reconstruction, you want the very best aesthetic result for your effort. Make sure you choose a highly-experienced and artistic surgeon who has the absolute lowest rate of complications.

 If there is not a surgeon in your area experienced with the method you prefer, know that many women travel to access surgeons who are. Their clinics may help with travel arrangements and accommodations, as well as dealing directly with insurance companies regarding out-of-network patients. Preliminary consultations can occur by phone, and openings in surgical schedules are maintained for women needing surgery in a timely manner.