Imagine you had to choose exactly how erect your nipples would look for the rest of your life.

The sense of loss women feel after losing one or both nipples post-mastectomy is hard to describe, but perhaps this sums it up best: "Without a nipple, a breast isn't a breast—it's just a mound," says Joshua Levine, M.D., FACS, a natural breast reconstruction surgeon in New York City.

That’s why nipple reconstruction can

have a huge impact on the emotional-recovery process of mastectomy patients, say experts like Anastasia Bakoulis, D.O., assistant professor of surgery at Stony Brook School of Medicine’s breast center.

Her research suggests that about 90 percent of women now opt for breast reconstructions after mastectomies (up from just 10 percent in the 1980s). Nipple-sparing mastectomies are a choice for some, depending on the specifics of the cancer, but others are limited to options like tattooed-on nipples, reconstructions built from, say, leg tissue, or prosthetics that need to be reapplied for each use.

Research backs up the fact that nipples play a key role in the emotional-recovery process: One recent study, for example, found that women reported significantly higher levels of psychosocial and sexual well-being after a nipple-sparing mastectomy, compared to a total mastectomy.

"The nipple restores a sense of normalcy and health to a woman," says Levine. "It can help her leave the memory of surgery and disease behind her."

For patients who can’t keep their nipples, reconstructed, tattooed, or prosthetic options can greatly improve their quality of life. "I've seen women who have refused to remove their bras in front of their husbands for years that have no problem whipping off their tops to show off their marvelous breasts today," says Friday Jones, a tattoo artist who does post-operative tattooing. "It's like they finally recognize themselves again."

Here, five women who have undergone post-mastectomy breast reconstruction share how they dealt with the loss of their nipples—and how it impacted their lives.

—Amber Brenza