Breast reconstruction after a mastectomy can be done by several different procedures, but does not immediately result in a fully featured breast that is identical to your remaining breast or your lost breast. Newly reconstructed breasts are called "breast mounds" and don’t come with nipples and areolas. You don’t have to have a new nipple and areola created, but if you do, your reconstructed breast is considered complete. Nipple and areola reconstruction are separate procedures, which are done three or four months after your mastectomy, or after you finish chemotherapy.
A completely reconstructed breast should look like your original breast, restoring your symmetry. You should be able to wear your usual bras, blouses and even swimsuits. In the nude, it will be less obvious that you have a "new" breast if your reconstruction is complete, but scars will still remain. Some of us don't go for the full treatment, and stop before completing reconstruction. Geralyn Lucas writes in her book "Why I Wore Lipstick to My Mastectomy" that she chose to skip nipple reconstruction, and have a heart tattooed over her nipple area, as a mark of survival. Self-adhesive nipples are also available, to use during healing, or as a long-term option.
Nipple and areola reconstruction can be done right in your plastic surgeon's office using local anesthesia. Nipples can be created with a few strategically-placed sutures, and areolas are created with a painless tattoo. Skin for creating the new nipple can come from the breast skin, or other locations on your body. Nipples created in this way will not have the physical sensitivity of your original nipple, since they won't have the same nerves and blood supply as a real nipple.
Nipple reconstruction surgery takes around two hours, and requires that you wear a ring-shaped dressing to support the tissue for several weeks. A separate office visit must be scheduled to have the tattoo done which provides coloring for the nipple and areola. These procedures usually cause little pain, unless you've had skin grafted from another place on your body. In that case, the spot where skin was harvested may be tender while the incision heals.
There are many different techniques for nipple reconstruction. Discuss your options with your plastic surgeon, to see which may be best for you.
Source: American Cancer Society. Breast Reconstruction After Mastectomy. Nipple and Areola Reconstruction. Revised: 09/06/2007.