Nipple Sparing Mastectomy

What is a nipple-sparing mastectomy?

A nipple-sparing mastectomy (NSM) is a mastectomy in which the inside of the breast is removed while preserving the skin, nipple and areola.  A variety of  incisions may be used for a nipple-sparing mastectomy. Dr. Holmes most often performs h idden-scar nipple sparing mastectomy, which is performed through an incision in the natural skin fold under the breast. This produces a scar that is hidden from view from the front of the breast.  Lymph node surgery, if needed, can often be performed through the same incision.  In some cases, the location and closeness of cancer to the skin requires placement of the mastectomy incision in other locations. NSM can be performed for cancer surgery and for cancer prevention (prophylactic), and is always combined with immediate breast reconstruction using an implant, tissue expander, or tissue flaps.

What is the advantage of a nipple-sparing mastectomy?

The major advantage of NSM is that the outward appearance of the breast is preserved or improved.  In addition, the procedure can often be performed from scars strategically placed under the breast, making them less visible. NSM is a safe procedure with a low risk of complications (<10%) and a very low risk of recurrence (<1%) of cancer in the nipple when performed by an experienced surgeon.

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Are you a candidate for nipple-sparing mastectomy?

NSM can usually be performed if the cancer is not too close to the nipple and areola. The procedure works best in breasts that are an A, B, and C-cup size.

Do you have breast cancer and are you thinking about preventive (prophylactic) removal of the opposite (contralateral) breast?

Women with breast cancer may choose contralateral prophylactic mastectomy (CPM) or preventive removal of the opposite, unaffected breast to maintain breast symmetry, to eliminate the need for annual mammograms, or to minimize anxiety about the future risk of cancer in the opposite breast. You can calculate your personal risk of contralateral breast cancer (CBC) by visiting the following link: https://cbc-predictor-utd.shinyapps.io/CBCRisk. CPM is usually covered by insurance. A 20-year risk of CBC of 5% or less is considered LOW.

What are the side effects of nipple-sparing mastectomy?

With any surgery, one should expect some pain and bruising. Pain is well managed with pain medications. Bruising will go away after a few days.  Permanent numbness of the breast and nipple areolar area should also be expected because the nerves of the breast and nipple areolar complex are removed at the time of NSM. Partial or complete necrosis (death) of the nipple or other areas of the breast skin may occur in 5-10% of women undergoing NSM, but in most of these cases the skin heals normally after some care. However, Dr. Holmes has an excellent track record of success with NSM.  Smoking, nicotine use, obesity, diabetes, and large breast size increase the risk of complications after NSM.

What are the alternatives of NSM?  

There are several alternatives to NSM: skin-sparing mastectomy, areola-sparing mastectomy, and total mastectomy:

• Skin-sparing mastectomy. Skin-sparing mastectomy is performed when the nipple and areola cannot be safely preserved due to closeness of the cancer to the nipple and areola. Skin-sparing mastectomy is almost always combined with immediate breast reconstruction. The nipple and areola may also be reconstructed.

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• Areola-sparing mastectomy. Areola-sparing mastectomy is performed when the nipple cannot be safely preserved.  Since most of the nerves to the skin are also removed during areola-sparing mastectomy, the preserved skin and areola usually remain numb permanently.  Areola-sparing mastectomy is almost always combined with immediate breast reconstruction. The nipple may also be reconstructed. 
• Total or simple mastectomy. Total or simple mastectomy is performed when most of the skin of the breast is removed. Total or simple mastectomy is most often performed when immediate breast reconstruction is not desired or planned.  However, breast reconstruction may be performed at a later date. Since most of the nerves to the skin are removed during mastectomy, the remaining skin remains permanently numb.   

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