Nipple

The sensory nerves to the nipple arise from the intercostal nerves coming off the spinal cord traveling on the under surface of the ribs. They give off posterior branches in the axilla and anterior branches just lateral to the sternum. We often dissect the 4th and/or 5th posterior intercostal nerves for 5 to 7 centimeters at the time of mastectomy. A sensory nerve on the DIEP flap can be connected to the breast nipple nerve to restore sensation to the new breast. Also the anterior branch can be coapted to the DIEP sensory nerve. Even without a nerve repair, the sensory nerves slowly grow into the DIEP flap resulting in some sensation in most patients over 12-24 months.

Most of my patients today have nipple sparing mastectomies. It is very important for the Breast Oncologic Surgeon to spare the medial intercostal nerves and blood vessels during the mastectomy. The most important one arises between the 2nd and 3rd rib cartilage just medial to the breast tissue being removed and just lateral to the sternum. This allows for better return of nipple sensation.

Sincerely,
Bob Allen,MD The sensory nerves to the nipple arise from the intercostal nerves coming off the spinal cord traveling on the under surface of the ribs. They give off posterior branches in the axilla and anterior branches just lateral to the sternum. We often dissect the 4th and/or 5th posterior intercostal nerves for 5 to 7 centimeters at the time of mastectomy. A sensory nerve on the DIEP flap can be connected to the breast nipple nerve to restore sensation to the new breast. Also the anterior branch can be coapted to the DIEP sensory nerve. Even without a nerve repair, the sensory nerves slowly grow into the DIEP flap resulting in some sensation in most patients over 12-24 months.

Most of my patients today have nipple sparing mastectomies. It is very important for the Breast Oncologic Surgeon to spare the medial intercostal nerves and blood vessels during the mastectomy. The most important one arises between the 2nd and 3rd rib cartilage just medial to the breast tissue being removed and just lateral to the sternum. This allows for better return of nipple sensation.

Sincerely,
Bob Allen,MD

This technique requires a highly trained breast cancer surgeon. It involves making small cosmetically placed incisions through which all of the breast tissue is removed. It is important that the entire core of breast tissue going into the nipple is removed and checked to be certain that it does not contain cancerous breast tissue. This must be done in a very delicate way to be certain that the blood supply to the nipple is preserved so that the nipple stays alive. This technique requires a highly trained breast cancer surgeon. It involves making small cosmetically placed incisions through which all of the breast tissue is removed. It is important that the entire core of breast tissue going into the nipple is removed and checked to be certain that it does not contain cancerous breast tissue. This must be done in a very delicate way to be certain that the blood supply to the nipple is preserved so that the nipple stays alive.

Difficult to say without examining you. There are small specialized 'oil' glands on the areola (brown part by the nipple) that are small (~2-3 mm). In general, any mass should be evaluated by a doctor - preferably a breast surgeon to make sure it is nothing to worry about. Difficult to say without examining you. There are small specialized 'oil' glands on the areola (brown part by the nipple) that are small (~2-3 mm). In general, any mass should be evaluated by a doctor - preferably a breast surgeon to make sure it is nothing to worry about.

There are several ways to reconstruct a nipple. I prefer to rearrange tissue that is already in the area. The tissue (skin and a little fat) is lifted and twisted into a small cylinder to resemble the natural nipple. A couple of my patient's have described it as being "a bit like Origami"! The nipple and new areola are then tattooed at a later date to recreate the normal pigmentation.

Some surgeons prefer to use grafts from other parts of the body such as the labia, groin crease, or remaining nipple.

Dr C
http://www.PRMA-enhance.com There are several ways to reconstruct a nipple. I prefer to rearrange tissue that is already in the area. The tissue (skin and a little fat) is lifted and twisted into a small cylinder to resemble the natural nipple. A couple of my patient's have described it as being "a bit like Origami"! The nipple and new areola are then tattooed at a later date to recreate the normal pigmentation.

Some surgeons prefer to use grafts from other parts of the body such as the labia, groin crease, or remaining nipple.

Dr C
http://www.PRMA-enhance.com

Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Richard M. Kline Jr., M.D. Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Richard M. Kline Jr., M.D.

Generally if there is retraction of the nipple, that is because there is cancer behind the nipple or areola, and it "draws" the nipple inwards. Depending on the exam and findings of the imaging studies (especially MRI), preserving the nipple and areola might not be possible. If the nipple and areola do need to be removed, sometimes a "central lumpectomy" can be performed - again this depends on the location and size of the tumor as well as the size and appearance of the overall breast. If a central lumpectomy is performed, radiation therapy will be needed, as with any lumpectomy. Radiation is generally not needed after mastectomy, unless there is a very large tumor, if there is invasion of tumor into the skin, or if multiple lymph nodes are involved by tumor.

I would make sure you get a good idea of the cosmetic results after central lumpectomy. In addition, remember that mastectomy is not necessarily a "better" operation - in most cases there is no long-term survival advantage to mastectomy compared to lumpectomy / radiation. Generally if there is retraction of the nipple, that is because there is cancer behind the nipple or areola, and it "draws" the nipple inwards. Depending on the exam and findings of the imaging studies (especially MRI), preserving the nipple and areola might not be possible. If the nipple and areola do need to be removed, sometimes a "central lumpectomy" can be performed - again this depends on the location and size of the tumor as well as the size and appearance of the overall breast. If a central lumpectomy is performed, radiation therapy will be needed, as with any lumpectomy. Radiation is generally not needed after mastectomy, unless there is a very large tumor, if there is invasion of tumor into the skin, or if multiple lymph nodes are involved by tumor.

I would make sure you get a good idea of the cosmetic results after central lumpectomy. In addition, remember that mastectomy is not necessarily a "better" operation - in most cases there is no long-term survival advantage to mastectomy compared to lumpectomy / radiation.

Today there are many options for mastectomy, especially for those with early stage cancer. In the past, most doctors made incisions across the breast or on the side of the breast. Today, many doctors perform this surgery from the underside of the breast, where scars are less noticeable. Why don’t all doctors do this? Some may be reluctant to learn new methods, and for others, perhaps they can’t be bothered. This type of surgery takes longer; surgeons are paid by the job, not the hour. Removal of the nipples is not always necessary. Doctors used to believe that nipple-sparing mastectomies were not effective because breast tissue remains. However, today, many doctors realize that sparing the nipples does not increase your risk of recurrence as long as the cancer is not in or near the nipples. When I was facing mastectomy, I wanted a doctor with cutting-edge thinking, someone who continuously learns new ways to perform surgery. If your doctor does not offer you options or is only able to give you ‘your mother’s mastectomy’, find a new doctor. After all, you wouldn’t buy an outdated cell phone, so why in the world would you accept outdated surgery?
I urge you to view the following link regarding nipple-sparing, beautiful mastectomies. Please note I do not agree with their discussion of incision placement, but if you follow the forum, you will hear others talk of below the breast placement.
http://community.breastcancer.org/forum/44/topic/745796
Today there are many options for mastectomy, especially for those with early stage cancer. In the past, most doctors made incisions across the breast or on the side of the breast. Today, many doctors perform this surgery from the underside of the breast, where scars are less noticeable. Why don’t all doctors do this? Some may be reluctant to learn new methods, and for others, perhaps they can’t be bothered. This type of surgery takes longer; surgeons are paid by the job, not the hour. Removal of the nipples is not always necessary. Doctors used to believe that nipple-sparing mastectomies were not effective because breast tissue remains. However, today, many doctors realize that sparing the nipples does not increase your risk of recurrence as long as the cancer is not in or near the nipples. When I was facing mastectomy, I wanted a doctor with cutting-edge thinking, someone who continuously learns new ways to perform surgery. If your doctor does not offer you options or is only able to give you ‘your mother’s mastectomy’, find a new doctor. After all, you wouldn’t buy an outdated cell phone, so why in the world would you accept outdated surgery?
I urge you to view the following link regarding nipple-sparing, beautiful mastectomies. Please note I do not agree with their discussion of incision placement, but if you follow the forum, you will hear others talk of below the breast placement.
http://community.breastcancer.org/forum/44/topic/745796