At Bedford Breast Center, our philosophy is that women facing breast cancer deserve not only the most effective treatment to cure their cancer, but also the absolute best possible aesthetic results. Therefore, in 95% of our patients, we perform a Nipple Sparing Mastectomy.
What is Nipple Sparing Mastectomy?
Traditionally, as part of the 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.
While technically more difficult to perform than traditional mastectomy, nipple-sparing mastectomy allows for women to have reconstructed breasts that look natural, normal, and even beautiful. This procedure can be performed on over the 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 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.
Below are before and after photos of nipple sparing mastectomy and breast reconstruction.
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 by the breast cancer surgeon, most of the breast skin is preserved, while the nipple, areola and breast tissue are removed. Retaining the skin allows for immediate reconstruction; it is performed 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.
Benefits of Nipple Sparing Mastectomy
There are many benefits to the nipple-sparing mastectomy. The aesthetic qualities of the breasts are unchanged (and occasionally enhanced), the shape and size of the breasts are preserved, and the incision is hidden in the natural crease below the breast.
In addition to preserving the look of the breast, studies have suggested that women who have nipple-sparing mastectomy enjoy enhanced self-image 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 natural 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, it has also been shown to 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 post-operative period. Our surgeons have a complication rate of under 8%.
It’s Hard to Find.
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 high in other breast centers, with over 20% of patients having major issues such loss of their reconstructions and mastectomy flap necrosis.
It’s Time to Raise the Standard of Care.
As this breakthrough procedure grows in popularity, we strive to set a high standard for our patients. We collect quarterly data and publish annually every outcome, complication, and operation. 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, and get the lowest complication rates possible, and the aesthetic results these brave women deserve.
Who is a Candidate?
Most women with breast cancer can be offered Nipple-Sparing Mastectomy. 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.
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.
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 to 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 to 70 percent with medication versus 95 percent with surgery.)
As drastic as removing “normal” breasts may sound, a prophylactic mastectomy procedure dramatically minimizes the risk of developing breast cancer in the high-risk patient. Close surveillance with exams and imaging studies strives to catch a cancer early. 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.
Other Conditions for Mastectomy
In women with dense or lumpy breasts, post-operative surveillance is very difficult and dangerous. MRI, breast ultrasound and screening mammogram studies 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.
Consultation with a breast specialist in mastectomy and breast reconstruction is recommended to enable patients to explore all options available and thereby 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.