Ask The Doctor-Is my inward nipple fixable?

pink flowerThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: 12 years ago, my cancer left me with a inward nipple, and a surgeon is telling me nothing can be done. I find that in today’s medical world that can’t be true. There must be someone who can fix it or make me one. Just wondering. Thank you!

Answer: The procedure to repair a retracted nipple depends on the reason the nipple is retracted. If you have had lumpectomy and radiation and the retraction developed after scar developed, then a procedure to reconstruct the breast may be the best approach. Do you happen to have a breast implant? Other causes are less involved to fix.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

What Technique Do You Use For Nipple Reconstruction?

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q:  Can you tell me how successful you have been in doing nipple reconstruction and what technique you use? I had one done from tissue gathered from my own breast, then had fat transferred but it is still flat. Now that I am losing the other breast (2nd mastectomy) I would like to have a protruded nipple even if just a bit on each breast. 

A: I use the “skate flap” technique, although many similar techniques using local tissue exist. There are, in my experience, two potential problems which may cause nipple reconstruction to be unsuccessful.

1) Sometimes, a portion of the flap just dies. This is, to a large extent, unpreventable and unpredictable, as these flaps are too tiny to be based on any known blood vessel. Additionally, the need to put the nipple in the proper location precludes altering its design to potentially improve blood flow.

2) We have learned that it is essential to protect the flap from the pressure of clothing until it is fully healed (at least one month). There are special domed “Tupperware” protectors made just for this purpose.

It helps to make the nipple larger than desired at first. That leaves a little leeway if things go awry, and it only takes a few minutes to reduce a nipple in the office if it ends up being too large.

Hope this helps, good luck.

Q: I have just been diagnosed with breast cancer of the right breast. The surgeon suggest bilateral mastectomy due to family history. Should I meet with a plastic surgeon before the surgery or get a 2nd opinion?

A: Whether or not you ultimately decide to have reconstruction (at the time of mastectomy, or later), you should at least speak with a plastic surgeon beforehand so that you know all of your potential options. Ideally, your breast surgeon already works with one or more plastic surgeons, and can help direct you to one.


Dr. Richard Kline

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

After Radiation, Mastectomy and Reconstruction, I’m Having Extreme Back Pain…Solutions?

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q:  About 6 years ago, I had a bilateral mastectomy with reconstruction. The plastic surgeon took one muscle from each side of my back to reconstruct each breast. Now I am experiencing extreme back pain on the right side. This is the side where the tumor was. This was a second occurrence.

In 1993, I had a lumpectomy with chemo and radiation to this right breast/side. The extreme pain feels like it is muscular in nature on the right side. Is this normal and something I just have to live with, or might there be some other treatment for muscle pain? Should I have it checked out for a possible disc problem causing the radiating pain in my back? Should I check out physical therapy or is it too late for this therapy? I am at a loss and hate enduring this constant pain.

A: Thank you for your question, I am sorry you are experiencing pain.

When the pain first developed and exactly where it is located could help determine what the cause is and how to treat it. If it is your back in the area where your back muscle was removed it could possibly be related to your spine discs or from your body compensating for not having the muscle. If you have an implant and the discomfort is in the breast area it is possible that scarring around the implant is the cause.  Most importantly you should let your plastic surgeon,  breast surgeon and oncologist know so they determine the cause and treatment.

Your oncologist should determine if you need any special scans or tests with regard to your breast cancer history and your plastic surgeon can determine if it has to do with the reconstruction and if there is a fix.


Q: I had nipple reconstruction a month ago. After a summer with not having to wear a bra, I’m now having remorse that I didn’t go for 3-D tattoos. Two questions:

Can one have the reconstructed nipples removed?

Is there a way to flatten the nipples over time?

I understand that some nipples flatten naturally but others don’t. I wish I had thought all this through the way I did for every other decision I made during the breast cancer journey. Is there any thing else you would suggest for someone with buyer’s remorse regarding nipple reconstruction? 

A: Thank you for your question.

I suggest you ask your surgeon as it may depend on how the reconstruction was done. Otherwise I would also expect over time the nipple will flatten. It takes about 9 months. It can always be made smaller easily in the office with only numbing medicine.

Dr. James Craigie

Center for Natural Breast Reconstruction


Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

I’m Having a Strange Skin Sensation Post-LD Flap Reconstruction. Will This Pass?

This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your miscellaneous questions.


Is it possible to have a nipple transfer (from someone who has not had breast cancer)? If so will they ‘work’?

Theoretically possible if that someone is your identical twin, but probably not practical even then, as it is easier and generally more successful to reconstruct a nipple from ordinary skin.


I am 4 weeks post-mastectomy and LD Flap reconstruction. I have the sensation that my skin is stuck to my ribs on my back. Will this pass?

In all probablility, yes. Symptoms of tightness and discomfort can persist for months, and occasionally seromas (fluid collections) can persist for over a year, but most people eventually recover completely.


Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!


Your Questions About Breast Reconstruction Answered

nipple sparing mastectomyThe questions below are answered by the breast reconstruction surgeons of The Center for Natural Breast Reconstruction, Dr. James Craigie and Dr. Richard Kline:

If a woman has flap reconstruction, are the nipples reconstructed at the same time or at a later date?

While it is sometimes possible to reconstruct the nipples at the same time, usually for various reasons it is preferable to delay the nipple reconstruction until a later time. Nipples must be positioned very carefully to look their best, and that means the final shape of the breast mound must be stable prior to choosing the nipple position. Tissue flaps must be carefully monitored for several days following the initial reconstruction to assure early detection of any problems, and temporarily leaving extra flap skin on the breast mound helps greatly with this. Additionally, FWIW, the skin that the nipples are reconstructed from, whether flap skin or native breast skin, frequently has no sensation, making it even easier to reconstruct the nipples as a small procedure in the office.

If a woman is a candidate for a nipple-sparing mastectomy, can she have flap reconstruction and retain her nipples?

Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Can you explain what you mean by a muscle-sparing free flap breast reconstruction?

“Muscle-sparing” simply means that NO MUSCLE TISSUE at all is removed. This does not necessarily mean that the muscle suffers no injury, as the blood vessels which nourish the flap usually must be removed from the muscle, but the amount of damage is commonly small enough that the muscle ultimately recovers its function.

What are some criteria that may disqualify a patient for breast reconstruction?

Any serious medical conditions which would prevent a patient from tolerating 4-8 hours of general anesthesia would prevent her from having flap reconstruction. Some medical conditions, such as diabetes, increase various risks (in particular, risks of wound healing problems), but do not disqualify the patient from having reconstruction. We do not perform reconstruction on patients who are currently cigarette smokers (or use nicotine in any form) because nicotine’s effects on wound healing after flap surgery is frequently catastrophic. However, most patients will clear all nicotine form their system after a month’s abstinence. Some very slender patients do not have enough donor tissue anywhere on their bodies for flap reconstruction, but this is quite uncommon.

For more information on breast reconstruction, visit our website.