What is Nipple-Sparing Mastectomy?
Nipple-sparing mastectomy is a procedure for removing cancerous breast tissue that leaves the nipple-areola complex intact.
While technically more difficult to perform than traditional mastectomy, nipple-sparing mastectomy (NSM) allows for women to have reconstructed breasts that look natural, normal, and even beautiful.
At Bedford Breast Center in Beverly Hills, our goal is to cancel breast cancer, not beauty. We can perform this breast cancer treatment on about 95% of women whose breast cancer is not in the nipple.
This is a safe procedure; studies have shown that preserving the nipple and areola does not negatively affect the cure rate as compared to removing the nipple. In fact, this technique lowers overall risk, decreases cost, and minimizes pain. NSM is becoming an increasingly common breast cancer treatment as studies continue to prove its effectiveness and safe results.
Below are before and after photos of nipple-sparing mastectomy and breast reconstruction surgeries performed at our Beverly Hills medical center.
Age: 28, from Manhattan Beach, CA. Bilateral nipple/areola-sparing mastectomy with Cassileth Direct-to-Implant Reconstruction. Left breast 492cc implant, right breast 533 cc implant.
How is a Nipple-Sparing Mastectomy Performed?
Our medical center safely offers NSM as our breast cancer surgeons are reconstructive surgery experts and highly trained in this procedure.
We always screen each patient carefully to make sure this is a safe option for them. During your consultation for breast reconstruction surgery at our Beverly Hills medical center, we will review your test results and share your mastectomy options, including a nipple-sparing mastectomy, if applicable.
Traditionally, during mastectomy, the nipple and areola are removed, as well as a portion of breast skin, leaving a long scar across the chest.
In NSM, we do not remove the nipple, areola, or any breast tissue. We spare these very important aesthetic aspects of the breast and make only a small scar, which is hidden under the fold of the breast, similar to a breast augmentation scar.
Our expert breast surgeons perform this surgery with the patient under general anesthesia. The incision is hidden under the breast or in the underarm area, depending on each patient, so we can remove the cancerous breast tissue underneath.
What Are the Benefits of a Nipple-Sparing Mastectomy?
As this breakthrough breast surgery grows in popularity, we strive to set a high standard for our patients. Our goal is to not only perform the best work we can at all times, but also to raise the bar for both ourselves and others.
It is our hope that women everywhere will demand nipple-sparing mastectomy, whenever safe, with the lowest complication rates possible and the aesthetic results these brave women deserve.
There are many benefits to NSM such as:
- The aesthetic qualities of the breasts are unchanged or even improved
- The shape and size of the breasts are preserved
- The incision is hidden in the natural crease under the breast
In addition to preserving the look of the breast, studies show that sexual well-being is significantly higher in women who underwent NSM compared to a skin-sparing or traditional breast mastectomy. While a skilled plastic surgeon can construct a realistic nipple, it will not have the exact appearance of a natural nipple.
To illustrate the visual difference between the two breast surgeries, below is a before and after picture of a patient who underwent a nipple-sparing mastectomy on one breast, and a skin-sparing mastectomy on the other.
Age: 42, from Malibu, CA. Right breast: nipple-sparing mastectomy (left in photo), left breast: skin-sparing mastectomy (right in photo). Bilateral Cassileth Direct-to-Implant Reconstruction. 617cc implants.
It’s Safe
Studies have shown that not only is NSM just as effective as traditional mastectomy to treat breast cancer, but it can also provide a slightly better survival rate than traditional mastectomy.
A literature review of nineteen peer-reviewed studies from 1991 to 2014 reveals that NSM patients were in fact slightly more likely to remain cancer-free during the critical five-year postoperative period.
Nipple-Sparing Mastectomy in Beverly Hills Before and After Results
Our specialized team of breast surgeons can perform direct-to-implant reconstructions, providing women with natural-looking breasts during the same operation.
Age: 41, from Sherman Oaks CA. Bilateral nipple-sparing mastectomy with Cassileth Direct-to-Implant Reconstruction. 240cc implants. Fat grafting to breasts was performed during a second surgery.
Age: 29, from Westlake Village, CA. Bilateral nipple-sparing mastectomy with Cassileth Direct-to-Implant Reconstruction. 304cc implants.
Who is a Candidate for Mastectomy?
Most women with breast cancer can be offered NSM. The only absolute contraindication is when the nipple is involved with the tumor. Nipple-sparing mastectomy may also be contraindicated in women with low nipple position or very large breast size.
However, not all breast centers offer this surgical option. At the 2015 annual ASBS (American Society of Breast Surgeons) annual meeting, we learned that less than 5% of entire breast centers offer their patients nipple-sparing mastectomy, due to the technical difficulty of the technique.
Even in these rare centers, fewer than 30% of women are considered candidates. The complication rates are higher in other breast centers, with over 20% of patients having major issues such as loss of their breast reconstructions and mastectomy flap necrosis. But not at Bedford Breast Center. Our breast surgeons have a complication rate of under 8%.
Who is Not a Candidate?
Patient candidacy for a NSM is often dependent on the provider, as many surgeons are still not trained in, or comfortable with this method. Contraindications are when the disease involves the nipple or in patients for whom the blood supply to the nipple is compromised.
BRCA Gene Mutation
You may also consider a full mastectomy if you have the BRCA gene mutation. Women with the BRCA gene mutation have a high risk of developing breast cancer in one or both breasts. Multiple studies have assigned a 57-86% chance of developing breast cancer in women identified with the BRCA gene mutation. In these cases, women choose to remove both breasts before cancer is identified.
Until genetic engineering is mastered, removal of the target organs at risk of breast cancer is the safest preventative treatment we currently have available. This is known as a prophylactic (preventative) mastectomy.
Anti-hormone treatment with Tamoxifen or Aromasin also decreases the probability of developing breast cancer in high-risk patients, but not as effectively as actually removing the entire breasts (50-70% with medication versus 95% with surgery).
As drastic as removing “normal” breasts may sound, a preventative mastectomy procedure dramatically minimizes the chance of developing breast cancer in a high-risk patient. Close surveillance with exams and imaging studies strives to catch cancer early. However, this is clearly a less aggressive or successful strategy to prevent breast cancer.
Gene-positive patients are at risk for the frequently lethal ovarian cancer as well, and removal of their ovaries is also recommended, as soon as they have completed childbearing.
Other reasons that a single or double mastectomy might be a reasonable preventive strategy are in cases of women with invasive lobular cancer. These women have a higher possibility of developing a new primary cancer in the opposite breast than those with invasive ductal cancer.
This fact, coupled with the increased difficulty in identifying lobular cancer with diagnostic imaging such as an MRI or a mammogram, may lead a woman to consider bilateral preventive mastectomies. Below is a picture of a patient who underwent the preventive bilateral prophylactic mastectomy with direct-to-implant breast reconstruction.
Age: 44, from Los Altos, California. Patient was BRCA + and had a family history of breast cancer. Surgery was bilateral prophylactic mastectomies with Direct-to-Implant Reconstruction. 450 cc silicone implants were used and Alloderm.
What is Skin-Sparing Mastectomy?
Skin-sparing mastectomy surgery (sometimes called breast-conserving surgery), is performed for women who have cancer in the nipple or areola. With this procedure, the breast cancer surgeon can preserve most of the skin on the breast, while the nipple, areola, and breast tissue are removed.
Retaining the skin with this breast conserving procedure allows for immediate breast reconstruction with a minimal incision on the chest, allowing for an excellent cosmetic result. There is no measurable difference in the cure rate between the skin-sparing mastectomy and the traditional breast mastectomy.
Below is a picture of a patient who underwent a total skin sparing mastectomy.
Age: 48, from Palos Verdes, CA. Bilateral skin-sparing mastectomy with Cassileth Direct-to-Implant Reconstruction. 240cc implants.
Other Conditions for Mastectomy
In women with dense or lumpy breast mounds, post-operative surveillance is very difficult and dangerous. MRI, breast ultrasound, and screening mammograms in these women are difficult to interpret. Additionally, cancer found during surgery, which was missed or underestimated by imaging studies, would indicate that future surveillance strategies are not reliable.
In women who have large tumors in small breasts, lumpectomy is less cosmetically acceptable than mastectomy with reconstruction and implants. Preventive mastectomy may be indicated in patients without the known BRCA gene mutation but with a strong family history of breast cancer and other risk factors.
How Long is Recovery From a Mastectomy?
Many patients spend 1 to 2 nights with expert nursing care in a curated post-operation environment after their breast conserving surgery to rest and recover, but others go home with a family member the same day, after an observation period. Your age and overall health affect how quickly your body heals.
You will likely experience some discomfort after your procedure. You should not try any strenuous activities, but instead focus on the physical therapy exercises we provide.
If you are experiencing any of the following symptoms, please contact us right away:
- Shortness of breath or other breathing irregularities
- Confusion or lack of alertness
- Chest pain, pressure, or tightness
- Redness, swelling, or pus drainage from your incision
- Prolonged fever
- Urination or bowel movement troubles
- Pain, redness, or swelling of your leg
- Unexpected bleeding
If you are unsure if you should come in, please call us and we can help.
What are the Risks of Nipple-Sparing Mastectomy?
As with any surgical procedure, there are risks. The biggest risk from a nipple-sparing mastectomy is nipple-areola complex necrosis. This can lead to the loss of the nipple. It can occur if blood supply to the nipple is compromised. This occurs in about 12% of NSM patients in the US.
Another concern many have about this technique is the risk for the recurrence of breast cancer. However, studies continue to disprove a higher likelihood with NSM than for women who undergo a complete mastectomy.
Consult With A Breast Specialist in Beverly Hills
A consultation with a breast specialist in mastectomy and breast reconstruction is recommended to enable patient exploration of all options available to make the best surgical decision for their case.
If a mastectomy is chosen as your breast cancer treatment option, you want to receive the most superior results in single or double mastectomy Los Angeles has to offer. For more information or to schedule an appointment contact one of our breast specialists.
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– Bedford Breast Center
Leslie F. Memsic, MD, FACS
