Nipple Sparing Mastectomy
Serving Patients in Jacksonville, Florida
Nipple-Areola Sparing Mastectomy
Nipple sparing mastectomy (NSM) is becoming a more common procedure for women with breast cancer. In the past, nipple sparing mastectomy was known as subcutaneous mastectomy and many of the studies from years ago demonstrated that in certain women, preserving the nipple is a viable option.
It is imperative that more breast tissue is removed during a nipple sparing mastectomy when compared to prior subcutaneous mastectomies. At Desai Plastic Surgery, we work with several surgeons capable of performing this procedure.
When Dr. Halsted began performing radical mastectomies several decades ago, it took time for physicians and surgeons to make a transition to the modified radical mastectomy, which aimed at preserving the pectoralis major muscle. The change came when several scientific studies demonstrated no difference in survival or local recurrence of the breast cancer. The same transition has also occurred from modified radial mastectomy to skin sparing mastectomy. A skin sparing mastectomy is when all the skin except for the nipple-areola are preserved. Studies have also shown to be safe from an oncologic perspective.
However, nipple sparing mastectomy is a fairly new procedure and long term data does not exist proving its complete safety. The early data from about the first 1000 patients is that nipple sparing mastectomy in the appropriate patients is safe from the perspective of overall survival and local recurrence.
Nipple sparing mastectomy for Breast Cancer
Are you a candidate for nipple sparing mastectomy according to the current scientific studies.
- How close is your cancer from the nipple.
- The cancer should be at least 3-4 cm away from the nipple-areola complex.
- How large is your tumor?
- Patients with inflammatory breast cancer and tumors greater than 3-4 cm are not candidates
- Current breast size
- Patients with significant enlarged breasts such as breasts either size D or greater are likely not candidates
Nipple sparing mastectomy for Prophylaxis (Preventing Breast Cancer)
Women undergo risk-reduction mastectomy for a variety of reasons including:
- Test positive for a mutation in the BRCA 1/2 genes.
- Strong family history of breast cancer without a positive genetic test.
- Women undergoing mastectomy for cancer and wish to reduce their risk in the opposite breast.
The issue in performing nipple sparing mastectomy for risk reduction is centered around leaving the milk ducts that are present within the nipple itself. Most cancers do not involve the nipple and no cancers have been reported originating in the nipple with the exception of Paget’s disease. The nipple is a fairly superficial structure that is easy to monitor and evaluate.
In addition, most believe that breast cancers begin in small ducts, not the large ones found in the nipple. The study demonstrating the risk reduction for genetically positive women had a number of patients that underwent a less aggressive method of nipple sparing mastectomy. However, it should be noted that no studies have demonstrated that nipple sparing mastectomy for prophylaxis is valid or invalid.
Surgery and Recovery after Nipple Sparing Mastectomy
Nipple sparing mastectomy is a technical operation that can result in complications such as skin necrosis. Skin loss or delayed healing results from a number of various factors including:
- Surgeon performing the nipple sparing mastectomy
- Size of the breast (larger breast are more prone to wound healing problems)
- Nicotine use
- Preexisting scars.
- Choice of incision used for nipple sparing mastectomy
Often extensive bruising can occur after nipple sparing mastectomy and the skin generally recovers with proper care. Most women do lose sensation after both skin sparing and nipple sparing mastectomy.
To learn more, call your breast reconstruction experts at Desai Plastic Surgery today (904-262-3372) to schedule your consultation. We would be happy to work with your breast surgeon or recommend one for you.
Desai Center of Plastic & Reconstructive Surgery
14540 Old St. Augustine Road Suite #2391 | Jacksonville, Florida 32258