What is Nipple-Sparing Mastectomy
By: Courtney Floyd
I have received numerous calls recently regarding nipple-sparing mastectomy. I thought sharing some valuable information from our website on the procedure would be helpful.
Please also watch PRMA patient Rhonda discuss her experience with traveling from out of state for DIEP flap breast reconstruction with nipple-sparing mastectomy!
What is Nipple-Sparing Mastectomy?
Nipple-sparing mastectomy preserves the nipple and areola and all the breast skin envelope around it. Only the breast tissue under the skin and nipple-areola is removed. A skin-sparing mastectomy also preserves the breast skin envelope but unlike the nipple-sparing procedure, removes 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 depending on the location and distance from the nipple-areola. Recent studies strongly suggest that patients with cancers even closer to the nipple may also be candidates for the procedure without compromising cancer care. Patients who need a significant breast lift for the best cosmetic results are not ideal candidates.
During the surgery, the breast tissue on the underside of the areola is shaved away. In patients that have a known breast cancer, this tissue is sent as a biopsy 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+ and other genetic syndromes, strong family history) are the best candidates.
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?
Patients must be prepared to lose all nipple sensation. In cases where some nipple-areola sensation is preserved or returns over time, the feeling is typically well short of what Mother Nature provided.
Shaving away the breast tissue from the underside of the areola can sometimes compromise the blood supply to the area. 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 very uncommon when the procedure is performed by surgeons experienced with this technique.
At PRMA, we are able to check the blood flow intra-operatively if there is a concern that the nipple-areola may not survive. In the unlikely event 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.