Nipple-Sparing Mastectomy

What is a nipple-sparing mastectomy?

A nipple-sparing mastectomy (NSM) is a type of mastectomy — surgery to remove your breast tissue — that spares your nipple, areola and skin. This leaves a skin pocket to allow for reconstruction after the mastectomy.

Who is a candidate for nipple-sparing mastectomy?

You might be a candidate for nipple-sparing mastectomy if you plan to have reconstructive surgery at the same time as your mastectomy. You may also be a candidate if you:

• Have a single, small tumor that’s well isolated from your nipple, areola and skin: It won’t work if you have an advanced or aggressive type of breast cancer that might invade these tissues.
• Are in relatively good health overall: Your surgeon might not recommend NSM if you’ve recently had radiation therapy or have another condition that could affect how well you heal.
• Plan to have a prophylactic mastectomy due to high breast cancer risk: A prophylactic mastectomy removes one or both breasts to reduce your risk of breast cancer.

What happens before you have a nipple-sparing mastectomy?

Before scheduling your nipple-sparing mastectomy, your surgeon will take images of your breast with a mammogram, an ultrasound or an MRI. They’ll also:

• Discuss the pros and cons of the procedure with you, as well as other options: You’ll consider your overall cancer treatment plan, cosmetic goals and different ways of achieving those goals.
• Review your health history and order routine screenings: They’ll want to know that you’re fit for a longer surgery, and that you have good blood flow to your tissues so they can heal well.

What happens in a nipple-sparing mastectomy?

In a nipple-sparing mastectomy, your surgeon will remove all the tissue that fills your breast while keeping the skin, nipple and areola intact. Typically, a cancer surgeon works closely with a plastic surgeon on this procedure.

Your surgeon will:

1. Discuss in advance where they’ll place the cut (incision): During the surgery, they’ll make the incision where you discussed.
2. Remove all your breast tissue from under your skin: They’ll leave a thin layer of subcutaneous fat to provide blood supply to your skin.
3. Reconstruct your breast, if planned: Depending on your plan, your plastic surgeon might fill your breast “envelope” with either an implant or a tissue graft (mainly fat) taken from somewhere else on your body. Or you might choose to go “flat.”

How long does a nipple-sparing mastectomy take?

The timing of a nipple-sparing mastectomy can vary from person to person. It depends on the size and shape of your breast.

What are the potential benefits and risks of nipple-sparing mastectomy?

When it’s successful, a nipple-sparing mastectomy can be associated with a higher overall satisfaction rate compared to other types of mastectomies. But there’s a risk it won’t succeed if the nipple loses its blood supply during healing. The risk of breast cancer recurrence after NSM is the same as with other types of mastectomies.

Benefits

The primary benefits include:

• More natural appearance: NSM produces a cosmetic result that looks more like your original breast. This often includes less noticeable scars. Women report feeling better about this result overall. It feels less like “losing” the breast and leads to better self-esteem after mastectomy.
• Potential for keeping some sensation: In some people who have nipple-sparing mastectomies, some sensation eventually returns to the nipple. Based on current studies, the chance of this happening is probably less than 50%.

Risks

The primary risk is losing your nipple. The NSM operation can temporarily disrupt the blood flow to your skin and nipples. Blood flow should return with healing. But if your breast doesn’t heal well, and blood flow isn’t restored, the tissues can start to die.

What is the recovery like after nipple-sparing mastectomy?

A nipple-sparing mastectomy is usually an outpatient surgery. That means you go home the same day. Certain people may need to stay overnight at the hospital, but not always. Your clinical care team will make sure you’re healing well and provide pain relief as needed. They’ll teach you how to care for your incision wound and surgical drains at home. These drains will stay in place for about two weeks.

Bruising and swelling should go down in about a week. By this time, most people manage with over-the-counter pain relievers. You should avoid intense activity. But make sure to practice your arm exercises to prevent arm and shoulder stiffness. Most people return to their normal activities in a month or two.

When should I call my healthcare provider?

Contact your provider if you notice any signs of complications during your recovery, like:

• Infection: Signs may include heat and swelling around your incision, skin discoloration or fever.
• Persistent pain: Pain that doesn’t improve with time or medications is a red flag.
• Swelling: Increased swelling in your arms or legs.

What is the nipple delay technique?

The nipple delay technique is a staged approach to performing a nipple-sparing mastectomy. Your surgeon first performs a breast reduction. Larger breasts tend to have less successful results with NSM. Reducing them in advance can improve the procedure’s chance of success.

But for some people with breast cancer, surgical delay isn’t the safest option. It might be more important to remove the cancer as soon as possible.

What are the alternatives to nipple-sparing mastectomy?

If you aren’t a candidate for nipple-sparing mastectomy, you might consider:

• Nipple reconstruction: After removing your nipple, your plastic surgeon can reconstruct it. This often involves taking a skin graft from somewhere else on your body.
• Nipple tattoo: Tattoo artists can create a 3D image of a nipple on your skin. Your surgeon may be able to spare your breast skin even if they can’t spare the nipple (skin-sparing mastectomy).
• Nipple prosthesis: Prosthetic nipples, made of silicone, can attach to a reconstructed breast with a mild adhesive. You can also go flat and wear a silicone breast that includes a nipple.