Nipple-sparing mastectomy is the latest evolution in mastectomy technique. When combined with immediate breast reconstruction, it provides superior cosmetic results without compromising cancer treatment.
At PRMA, we routinely offer nipple-sparing mastectomy to appropriate candidates. The procedure can be performed in conjunction with any type of breast reconstruction.
What is a Nipple-Sparing Mastectomy?
A nipple-sparing mastectomy preserves the nipple and areola and all the breast skin envelope around it. Only the breast tissue ("parenchyma") under the skin and areola is removed. A skin-sparing mastectomy also preserves all the breast skin envelope but in contrast to the nipple-sparing procedure, includes removal of the nipple and areola.
Who is a Candidate?
Nipple-sparing mastectomy is an option for many patients with a small cancer located several centimeters away from the nipple-areola complex. Patients with ductal carcinoma in situ (DCIS) can also be candidates, again depending on the location and distance from the nipple-areola.
During the surgery, the breast tissue on the underside of the areola is shaved away. In patients that have a known breast cancer, some of this tissue is sent as a biopsy ("frozen section") to pathology to make sure there is no cancer under the nipple or areola. If this biopsy is negative then the area can be preserved. If it is positive for cancer cells, the nipple and areola must be removed.
Patients seeking prophylactic mastectomy and immediate breast reconstruction due to their high risk of breast cancer (eg BRCA+, strong family history, Cowden's syndrome) are the best candidates.
Patients who do not need a signficant breast lift will have the best cosmetic results.
What are the Benefits?
Studies show that nipple-sparing mastectomy does not compromise cancer treatment when performed in appropriate candidates. Preserving the nipple-areola complex adds to the quality of the reconstruction and makes the results even more "natural" and cosmetically pleasing. The patient also avoids the additional steps of nipple reconstruction and tattooing.
What are the Risks?
Nipple sensation is usually lost completely. Even in cases where some nipple-areola sensation returns, the feeling will never be as Mother Nature provided.
Shaving away the breast tissue from the underside of the areola can sometimes compromise the blood supply to the area. This can cause healing problems. If the blood supply is damaged too much by the nipple-sparing mastectomy, part or all of the nipple-areola can die. Thankfully this is uncommon.
At PRMA we check the blood flow intra-operatively to ensure the nipple-areola will survive. In the unlikely event that the nipple-areola cannot be saved, it is removed to prevent wound healing complications and a new nipple and areola are reconstructed at a later time.
Where will the Scars be?
This depends on the size and shape of the breast, whether a small "lift" is needed, patient preference and surgeon preference. Scars can be placed around part of the areola, extend outwards or downwards from the areola, or be completely away from the areola at the breast crease ("inframmamary fold incision").