Nipple Sparing Mastectomy

Just diagnosed for the 3rd time & had a double mastectomy and reconstruction during one surgery 3 weeks ago. Had the BEST surgeons in Santa Barbara and am forever grateful to them. Surprisingly the skin sparing went very well especially on my 20 yr. old radiated breast. They both said that they would not be able to spare my nipples so I had already made an appt. for tattoos and was considering nipple reconstruction. But, my genius surgeons in the middle of surgery decided to spare one nipple and part of the areola of the current breast cancer breast. I was so shocked and happy when my family shared the news with me after I came out of recovery. I gasped when they told me. So, even though I look in the mirror and see many stitches and atypical breasts at this point in time in the game looking back at me, seeing my nipple and part of the areola makes everything (including my psyche) more at ease. We are all dealt different cards on this journey and this aspect of my recovery has definitely lifted my spirits. Others not going through this journey may say it doesn't matter, but it does and I am truly grateful. I would have dealt with whatever was handed my way, but again, I am very happy with my outcome and can't wait to see how 'they' turn out after my final implant surgery in April! I had a great experience with the skin sparring surgery although we weren't able to save the nipple on one of my breast. I was able to have reconstruction done at the same time of mastectomy because my plastic surgeon did a skin sparring/nipple sparring double mastectomy and reconstruction all at once. I must say the results on my self-esteem were tremendous. I was already without air and felt crappy from chemo, being able to spare myself the trauma to be without breasts for many months, even a year was something wonderful to me.

I am quite happy with the results. Both breasts being perfectly similar (just had a nipple graff a few months ago). I think this is a wonderful medical alternative when you are sure you want to have reconstruction done. I think the younger the patient the more pertinent this may sound.

Mary

If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

Richard M. Kline Jr., M.D. If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

Richard M. Kline Jr., M.D.

Involvement of the nipple with breast cancer, Paget's disease, inability of the surgeon to obtain a sufficient amount of normal tissue between the tumor and the nipple so there is adequate blood supply to the nipple. Involvement of the nipple with breast cancer, Paget's disease, inability of the surgeon to obtain a sufficient amount of normal tissue between the tumor and the nipple so there is adequate blood supply to the nipple.

My opinion is that properly performed nipple sparing mastectomy does not have increased risks for cancer recurrence. My opinion is that properly performed nipple sparing mastectomy does not have increased risks for cancer recurrence.

The nipple can be saved unless there is cancer involving the nipple. However for patients with large ptotic(droopy)breasts, saving the nipple may not be good from a cosmetic point of view since the nipple position will be very low on the reconstructed breast and will not have a good appearance. The nipple can be saved unless there is cancer involving the nipple. However for patients with large ptotic(droopy)breasts, saving the nipple may not be good from a cosmetic point of view since the nipple position will be very low on the reconstructed breast and will not have a good appearance.

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.

A properly performed nipple sparing mastectomy does appear to be a "safe" oncologic operation. Most commonly when a mastectomy is performed, the nipple and areola are removed. However given our more advanced imaging such as MRI, we are better able to determine the extent of disease prior to surgery (although no imaging study is perfect in this regard). For women with tumors away from the nipple/areolar complex, it may be reasonable to undergo a nipple sparing mastectomy with reconstruction. A properly performed nipple sparing mastectomy involves removing the majority if not all of the ductal tissue from within the nipple, to minimize the amount of tissue left behind at risk for breast cancer.

If you are interested in this approach, it is important to make sure your breast surgeon has experience with this procedure, as well as your reconstructive surgeon. It is also very important to realize that the nipple as well as the surrounding skin will almost always be numb after the surgery, and sensation may not ever return. Finally, depending on the natural breast shape and size and position of the nipple, a nipple-sparing approach may not provide the best cosmetic result. A properly performed nipple sparing mastectomy does appear to be a "safe" oncologic operation. Most commonly when a mastectomy is performed, the nipple and areola are removed. However given our more advanced imaging such as MRI, we are better able to determine the extent of disease prior to surgery (although no imaging study is perfect in this regard). For women with tumors away from the nipple/areolar complex, it may be reasonable to undergo a nipple sparing mastectomy with reconstruction. A properly performed nipple sparing mastectomy involves removing the majority if not all of the ductal tissue from within the nipple, to minimize the amount of tissue left behind at risk for breast cancer.

If you are interested in this approach, it is important to make sure your breast surgeon has experience with this procedure, as well as your reconstructive surgeon. It is also very important to realize that the nipple as well as the surrounding skin will almost always be numb after the surgery, and sensation may not ever return. Finally, depending on the natural breast shape and size and position of the nipple, a nipple-sparing approach may not provide the best cosmetic result.

Nipple sparing mastectomy is not an option for all women, and often is not even offered to those for whom it is. At the time, I had not heard of this option, but asked my surgeon if this was possible. He explained that it was a relatively new option but that in many cases, came with no added risk. Needless to say, I was thrilled when he said I was likely a candidate. He mentioned that if he were to find cancer in too close to the area, he would have to remove them, but that most likely I would wake up with my nipples. There was no question in my mind that I should have to agree to the removal of the nipples and added recon if it was not necessary.

Nipple sparing mastectomy is not an option for all women, and often is not even offered to those for whom it is. At the time, I had not heard of this option, but asked my surgeon if this was possible. He explained that it was a relatively new option but that in many cases, came with no added risk. Needless to say, I was thrilled when he said I was likely a candidate. He mentioned that if he were to find cancer in too close to the area, he would have to remove them, but that most likely I would wake up with my nipples. There was no question in my mind that I should have to agree to the removal of the nipples and added recon if it was not necessary.

Absolutely.

Nipple-sparing mastectomy can be performed in conjunction with any type of breast reconstruction.

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

Nipple-sparing mastectomy can be performed in conjunction with any type of breast reconstruction.

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.

One problem with this procedure is that while the cosmetic results can be excellent, the nipple and surrounding skin often lose sensation as a result of the surgery, so that while the appearance is more natural, it does not feel the same as prior to surgery. Also if the patient also needs a "lift" at the time of the reconstruction, a nipple-sparing technique might not be the best option. It is also important to make sure your breast and plastic surgeon are experienced in this technique. nipple sparing mastectomies are a relative new option for women, and not all breast cancer surgeons believe that we have enough years of follow-up to offer it yet. it is not offered in all institutions. many surgeons still feel that the nipple needs to be removed to safely remove all breast tissue to excise as much breast tissue as possible and reduce the risk of recurrence.