Revision After Mastectomy to Remove Nipples

It's possible (some people have nipples removed as a body modification done by someone who isn't even a medical surgeon; I know two people who've had it done that route and it was just like healing a cut that needed stitches), but you may run into trouble both finding a surgeon willing to do it and getting insurance to pay for it as, if they aren't causing you medical problems, insurance is likely to deem it cosmetic and not a 'revision', meaning you'll have to pay for it out of pocket.

If the issue is with the one that's always erect, and you'd just like a revision done to make it flat rather than remove it/both, that may be an easier sell as a revision to the insurance company and it'd likely be easier to find a plastic surgeon to perform the operation. It'd likely be a pretty minor in-office procedure to have that done.

It's also worth noting that most insurance companies have a time limit on how far out from the original surgery they'll pay for revisions, so you'll want to check with your insurance company on that since it's been a few years since you had your original surgery to see what their time limit is; it can range from 2-10 years, depending on the company and plan you have.

From what I know of the people I know who had it done cosmetically and by a body mod guy, it doesn't seem healing is too bad, so that's always a plus. They did nothing special aside from keeping the area extra clean and covered (so shirts or bras didn't irritate the sutures/wound area) for a couple of weeks.

I've also known a few women who have had areola reduction after theirs stretched after getting implants, and they've said it was a pretty easy recovery. One woman I know had to have permanent sutures stitched around her nipples because she didn't want to downsize her implants and it was pressure/stretching from the implants that had originally caused her areolas to stretch out like pancakes.

Depending on why yours are a size you don't like it may or may not require permanent sutures if you just want them reduced instead of removed. If they're large because yours were naturally large before, it's not likely to need anything like that but if they stretched after the implants, it's a possibility. That's another one that your PS will be able to better determine with an exam.

If they stretched due to the implants causing the stretching, even if they're reduced, they may re-stretch as the implants will still be putting the same amount of pressure on the area. That would be a case where your PS might recommend permanent sutures, but those have their own downsides, such as rejection, infection, and some women don't like that you can always kind of 'feel' the sutures if you touch the area.

Negatives of a full removal of the nipples that I can think of offhand would be:

- More scars, but if you scar well they'd eventually just fade and be less noticeable. If you're prone to keloids, it's possible you'd develop them.

- Possible infection, which is a risk with any procedure.

- Possible wound healing issues, especially if the skin on your breasts is thin or isn't in the best condition due to radiation treatments; if you've had rads, that'd definitely be worth discussing with your PS. It's also a possibility that the added pressure on the area from implants could make healing more difficult. Your PS would be better able to assess that through an in person exam. Even if there is enough skin laxity and thickness, anyone can have wound healing issues and there's not really a good way to predict that unless you have a really obvious risk factor.

- Some people find the look of no nipples to be jarring psychologically, even if they chose to remove them; most people get used to the look eventually, but some people can't and end up having the nipple either reconstructed or tattooed on. It's hard to predict whether or not you'll have that reaction until you're in the situation though. If your end goal is just to be able to not wear a bra with shirts, it may not be an issue. If looking 'natural' is a concern or is something you want for yourself, however, it may be a more difficult adjustment to how things look without a nipple (either your own, a tattooed one, or a reconstructed one).

- Either loss of sensation or hypersensitivity in the area, though if yours are already numb or have decreased sensation that's probably not an issue. If the area isn't already numb, there is a possibility that it will go numb or that the area around the scar will become hypersensitive. That can fade over time but, for some people, it may remain.