The answer to whether nipples are removed during a breast augmentation is generally no. Standard breast augmentation surgery is performed to increase the size and improve the shape of the breasts. The procedure is designed to preserve the entire Nipple/Areola Complex (NAC) and is minimally invasive to the breast structure. Surgeons focus on creating a pocket for the implant while maintaining the nipple’s natural position, blood flow, and sensation.
Nipple Preservation in Augmentation Surgery
The techniques used in breast augmentation are chosen to keep the nipple attached and its underlying connections intact. The implant is placed either behind the breast gland tissue (subglandular) or underneath the pectoral muscle (submuscular). In both cases, the implant sits deep within the breast, far from the visible surface of the nipple and areola.
Surgeons access the surgical pocket using several incision options, none of which require nipple removal. The most common locations include the inframammary fold (the crease under the breast), the transaxillary approach (through the armpit), or the periareolar approach (around the edge of the areola). Even the periareolar incision, which is closest to the NAC, is made carefully to avoid severing primary nerve and blood supplies.
Maintaining the neurovascular bundle—the network of blood vessels and nerves—is a priority to ensure the nipple remains healthy and sensitive. The breast tissue contains a delicate structure of ducts and nerves that surgeons strive to keep unharmed during the dissection process. By placing the implant behind the existing breast tissue, whether above or below the muscle, the integrity of the nipple’s attachment to the body is preserved.
When Nipple Repositioning or Removal Is Necessary
While simple augmentation preserves the nipple, other breast procedures often require manipulation or even complete removal of the NAC. These interventions involve significant reshaping or reduction of the breast tissue. The nipple may be repositioned to achieve a balanced aesthetic on a newly sized or shaped breast mound.
In a mastopexy, or breast lift, the surgeon repositions the nipple and areola higher on the breast to correct sagging. During this procedure, the nipple remains attached to the underlying breast tissue by a pedicle, which ensures blood and nerve supply are maintained. Only in cases of extreme breast sagging, or ptosis, is there a rare need to detach and graft the nipple, which carries a higher risk of sensation loss.
Breast reduction surgery, which involves removing glandular tissue, skin, and fat, also necessitates repositioning the nipple. In most reductions, the nipple is moved to a new, higher position while remaining connected to the breast via a column of tissue called a pedicle. However, in cases where a very large amount of tissue must be removed, the nipple may need to be entirely detached and reattached as a free nipple graft to ensure a safe and aesthetically pleasing outcome.
The nipple is removed during a standard mastectomy, which is often performed for breast cancer treatment. In this procedure, the entire breast, including the NAC, is removed to eliminate the cancer. If reconstruction is performed, a new nipple is typically created later through tissue grafting or specialized tattooing. A newer option, the nipple-sparing mastectomy, is available for select patients, allowing the surgeon to remove glandular tissue while preserving the skin envelope and the NAC.
Post-Operative Changes to Nipple Sensation and Function
Even when the nipple is preserved during breast augmentation, changes in sensation are a common post-operative experience. This side effect results from surgical dissection and the stretching of sensory nerves by the new implant volume. Patients often report temporary numbness, tingling, or a period of hypersensitivity in the nipple and areola.
For most patients, this altered sensation is temporary, with feeling gradually returning as the nerves heal over several weeks to months. However, a small percentage of women, ranging from 5% to 10%, may experience a permanent reduction or loss of sensation. The risk of sensory change is higher with larger implants, which cause greater stretching of the surrounding tissues.
Concerns exist regarding the impact of implants on future breastfeeding ability. While implants are typically placed behind the milk-producing glands, the chosen incision site can affect the milk ducts. Periareolar incisions, cut around the rim of the areola, carry a theoretical risk of severing some lactiferous ducts. However, studies show that while some women with implants may experience a lower milk supply, the majority can still successfully breastfeed, especially when the incision is placed in the inframammary fold or armpit.