As a breast surgeon, part of my job is to surgically remove breast cancer. But I have another extremely important role: to make sure women feel good and look good after their breast cancer has been treated. That’s why I’m pleased to share information on an innovative surgical procedure called nipple-sparing mastectomy that is offering women more options than ever before.
What Is Nipple-Sparing Mastectomy?
The American Society of Breast Surgeons has approved the use of nipple-sparing mastectomy for select women who are undergoing breast surgery.
As its name implies, the procedure removes the breast tissue but leaves behind the skin envelope, including the nipple and the pigmented area around it called the areola. Surgeons place an incision along the bra line or the outer edge of the breast. In contrast, a skin-sparing mastectomy removes the nipple and areola, leaving the woman with a scar in the middle of her breast.
The breast is then reconstructed, either with tissue from some other area of the body, like the belly or back, or with tissue expanders that can later be exchanged for permanent silicone implants.
Who Is A Candidate For Nipple-Sparing Mastectomy?
Nipple-sparing mastectomy is a great option for some women. The procedure is appropriate for women who have a strong family history of breast cancer or who carry the BRCA gene mutation and are seeking a risk reduction preventive (“prophylactic”) mastectomy.
Nipple-sparing mastectomy is also approved for use in women with a small, early-stage breast cancer if the tumor is not located close to the nipple.
Unfortunately, it is not appropriate for women who are large breasted or have significant ptosis (sagginess) of the breasts. These women benefit more from a skin-sparing technique so the breasts can be lifted and the nipple reconstructed at the appropriate position.
What Are The Risks of Nipple-Sparing Mastectomy?
There is a slight risk that the nipple tissue can heal poorly. That is why nipple-sparing mastectomy is discouraged in women whose history makes them prone to develop wound-healing complications. This includes smokers, diabetics, and those who have had radiation to the breast.
The success of nipple-sparing mastectomy requires open communication between the patient, her breast surgeon, and her plastic surgeon. It requires a properly chosen patient who understands the benefits and the risks of undergoing the procedure. In such a woman, the outcome can be exceptional—from both an oncologic and a cosmetic standpoint.
Note: Women who undergo nipple-sparing mastectomy have the opportunity to be part of a national registry organized by the American Society of Breast Surgeons. The purpose of the registry is to gather prospective data to follow both oncologic and cosmetic outcomes. Talk to your doctor for more information.