A Short History About Mastectomy
When nipple-sparing was first conceived, the initial worry was that people were more likely to have a recurrence and you were more likely to die of your cancer. Current studies show that that is not the case that you’re most likely to have a recurrence near the site of your primary tumor and not near the nipple. Several large studies show that women had nipple sparring mastectomy had no increased recurrence rates of cancer.
Oncological Safety of Nipple-Sparing Mastectomy
Nipple sparing mastectomy has gained traction as the standard of care for breast reconstruction. It has taken a while to get to this point. When breast cancer surgery was first designed, the concept was that cutting away more tissue would clear away more disease and result in better cure rates. In fact, the first surgery designed to cure breast cancer was very traumatic –– it was called a Halsted Radical Mastectomy and was aptly named – as the underlying muscles and all the skin were removed.
Radical mastectomies left women deformed. Surgeons have worked to improve cosmetic outcomes while still curing disease. Procedures have moved away from the idea of taking as much as possible and worked towards leaving behind what we feel is safe and that will not increase risk of future disease. Over time, less radical surgeries (such as two-step mastectomy plus expander became the standard).
Two Step Mastectomy Plus Expanders explained:
When this procedure first was implemented, the nipple was removed and a deflated implant shell (the expander) was placed at the time of mastectomy. The expanders were pumped up with saline over several months to slowly stretch the skin and muscle to allow for an implant to be placed during a second surgery.
In a second surgery, the expanders were removed and implants that were softer and more natural looking were left in place. Although the cosmetic results of this procedure were far superior to radical mastectomy, doctors felt they could improve upon this by preserving the skin and the nipple.
The Transition to Skin and Nipple Sparing Mastectomy
Over time, studies showed that there was not any additional recurrence of cancer by leaving this tissue. We felt comfortable that preservation of the skin was a safe and reasonable option. We continued to push the envelope and retain the nipple — statistics on nipple sparing showed that retaining the nipple does not increase the risk of recurrence (as compared to non-skin sparing mastectomies).
It is interesting to note that if the mastectomy is performed for cancer, recurrent cancer is more likely to show up nearer to the original tumor site than in the nipple or areola.
Over time, skin and nipple-sparing mastectomy has become the standard of care – with beautiful, aesthetic results and excellent safety for patients.