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. Our goal is to cancel 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 increasingly common as studies continue to prove its effectiveness and safe results.
Below are before and after photos of nipple-sparing mastectomy and breast reconstruction.
Age: 28, from Manhattan Beach, CA. Bilateral nipple/areola-sparing mastectomy with Cassileth One-Stage Breast Reconstruction. Left breast 492cc implant, right breast 533 cc implant.
Nipple-Sparing Mastectomy Technique
Our medical center safely offers NSM as our surgeons are experts and highly trained in this procedure. We always screen each patient carefully to make sure this is a safe option for them. Traditionally, during mastectomy, the nipple and areola were removed, as well as a portion of breast skin, leaving a long scar across the chest.
In nipple-sparing mastectomy, we do not remove the nipple, areola, or any breast skin. 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.
What to Expect from a Nipple-Sparing Mastectomy At Our Medical Center
During your consultation at our Beverly Hills medical center, we will review your test results and share your mastectomy options, including a nipple-sparing mastectomy, if applicable.
Our expert surgeons perform this procedure with the patient under general anesthesia. The incision is hidden under the breast or in the underarm, depending on each patient, so we can remove the cancerous tissue underneath.
Benefits of Nipple-Sparing Mastectomy
As this breakthrough procedure 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 patients 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. The aesthetic qualities of the breasts are unchanged or even improved. We preserve the shape and size of the breasts, and 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 procedures, 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 One-Stage Breast Reconstruction. 617cc implants.
Studies have shown that not only is nipple-sparing mastectomy just as effective as traditional mastectomy, 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 nipple-sparing mastectomy patients were in fact slightly more likely to remain cancer-free during the critical five-year postoperative period.
Beautiful Breasts with Nipple-Sparing Mastectomy
Our specialized team of plastic surgeons can perform one-stage breast reconstructions, giving patients natural-looking breasts during the same operation.
Age: 29, from Westlake Village, CA. Bilateral nipple-sparing mastectomy with Cassileth One-Stage Breast Reconstruction. 304cc implants.
Who is a Candidate?
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 procedure. At the 2015 annual ASBS (American Society of Breast Surgeons) annual meeting, we learned that less than 5% of 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 reconstructions and mastectomy flap necrosis. But not at Bedford Breast Center. Our 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. Patients 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, removal of both breasts before cancer is identified is warranted. Until genetic engineering is mastered, removal of the target organs at risk for cancer is the safest preventative treatment we currently have available. This is known as a prophylactic mastectomy.
Anti-hormone treatment with Tamoxifen or Aromasin also decreases the risk of developing breast cancer in high-risk patients, but not as effectively as actually removing the breasts (50-70% with medication versus 95% with surgery).
As drastic as removing “normal” breasts may sound, a prophylactic mastectomy procedure dramatically minimizes the risk 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.
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 patients have a higher risk 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 one-stage 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 One-Stage Breast 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. In this procedure, the breast cancer surgeon can preserve most of the breast skin, while the nipple, areola, and breast tissue are removed. Retaining the skin allows for immediate reconstruction with a minimal incision, 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 skin sparing mastectomy.
Age: 48, from Palos Verdes, CA. Bilateral skin-sparing mastectomy with Cassileth One-Stage Breast Reconstruction. 240cc implants.
Other Conditions for Mastectomy
In women with dense or lumpy breasts, 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.
Nipple-Sparing Mastectomy Recovery
Many patients spend 1 to 2 nights with expert nursing care in a curated post-operation environment after their procedure to rest and recover, but others go home 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.
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 nipple-sparing mastectomy 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 risk 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.