Nipple-sparing mastectomy is a newer, more conservative option for women who have immediate breast reconstruction; it preserves all of the breast skin, including the nipple and areola. Many women feel that this allows them to keep a small part—and from an emotional perspective, perhaps the most important part—of their natural breasts.
Here's what you should know about nipple-sparing mastectomy:
- It’s safe. Numerous studies over the past decade have shown that nipple-sparing mastectomy is a safe option for the right candidates. A meta-analysis of 19 previous studies involving more than 5,500 mastectomy patients concluded that nipple-sparing procedures result in similar rates of recurrence and survival compared to skin-sparing mastectomy procedures that remove the nipple.
- Not all women are candidates. Women with a small early-stage tumor that is not in the skin or close to the nipple may be eligible for nipple-sparing mastectomy. It is also viable for women who choose prophylactic mastectomy to reduce their unusually high risk of developing breast cancer due to a strong family history or inherited genetic mutation (like Angelina Jolie Pitt). Nipple-sparing procedures are not recommended for women who have multiple breast tumors close to the skin or nipple (although some experts consider this is acceptable if the tumors are not in close proximity to the nipple). The entire nipple and areola are removed if the tissue beneath the nipple is found to contain cancerous cells. Positioning nipples on the reconstructed breast can also be an issue; they may not be centered ideally if the reconstructed breasts are smaller or larger than the natural breasts.
- It facilitates cosmetically superior breast reconstruction. Because the breast skin, areola and nipple are retained, and the mastectomy scar is usually hidden under the breast or in the areola, your reconstructed breasts will likely appear as natural and as good or better than your own breasts before mastectomy. Although what is under the skin is different—breast tissue is replaced with breast implants or your own natural tissue—outwardly, the exterior of the breast appears intact and virtually unchanged.
- Incision placement is critical. Traditional skin-sparing mastectomy is performed through an elliptical incision around the nipple and areola. In a nipple-sparing mastectomy, a shorter incision is made just below the nipple—requiring the breast surgeon to remove the same amount of tissue through this smaller incision. Some women, particularly those with very large or sagging breasts, may need an additional horizontal incision from the nipple towards the arm, or an additional vertical incision from the nipple towards the bottom of the breast.
- The retained nipple may be different. Nipple sensation after nipple-sparing mastectomy varies, but it is usually considerably reduced because the fine nerves and small muscle fibers that trigger sensation and response are cut when breast tissue is removed. After nipple-sparing mastectomy, nipples may also flatten or look differently.
- Not all surgeons are qualified. Nipple-sparing mastectomy is now more common, but it is by no means standard. Many breast surgeons do not have the training or experience to perform the procedure, which is technically more demanding than other mastectomy procedures. Surgeons must be able to carefully remove the underlying tissue without compromising the blood supply the nipple needs to survive; leaving behind too much breast tissue increases the risk of another diagnosis.