Nipple Sparing Mastectomy

What is Nipple Sparing Mastectomy?

Mastectomy is a surgical procedure to remove one or both breasts to treat or prevent the spread of breast cancer. It usually involves the removal of breast tissue, the nipple, and areola. Nipple-sparing mastectomy is a variant of mastectomy that involves the removal of breast tissue, but leaves the nipple, areola, and breast skin intact. The main objective of the contemporary nipple-sparing mastectomy is to preserve the nipple-areolar complex (NAC) and skin covering with its blood supply while removing all breast tissue affected by or at risk of cancer.

The use of nipple-sparing procedure has been increasing in prominence and has gained the acceptance and reputation of being a safe option with a low risk of cancer recurrence for patients with breast cancer. Nipple-sparing mastectomy is mostly followed by immediate breast reconstruction.

Some of the most common methods of immediate breast reconstruction include:

• Implant-Based Reconstruction: This method involves inserting a permanent implant which is filled with silicone gel or saline (saltwater) under the skin and or muscle of the chest to create a new breast mound.
• Tissue Expanders: These are temporary implants that are placed behind the chest muscle or under the skin to expand the area and make room for implant reconstruction.
• Flap or Autologous Reconstruction: In this method, the patient’s own skin tissue is taken from another section of the body, such as the stomach, thigh, or buttocks and used to create a new breast mound.

Who is a suitable candidate for Nipple Sparing Mastectomy?

Nipple sparing mastectomy is indicated for patients who wish to preserve the original appearance and shape of the breasts and have small to moderate-size breast with minimal ptosis (breast droopiness). In cancer surgery, this procedure is only recommended when the tumour does not involve the nipple or tissue below the areola.

This procedure is ideal for women seeking risk-reduction preventive surgery like BRCA1 and BRCA2 faulty gene carriers.

What about ladies with larger cup size? Can they still have Nipple sparing mastectomy?

The answer is yes, but it's technically more challenging there are two ways to preserve the nipple in larger breasted ladies.

• If their condition allows, they can have a breast reduction which reduces the size of breast envelope and allows nipple preservation in the next surgery which will be nipple sparing mastectomy and reconstruction.
• Other option will be to perform a procedure known as skin reducing mastectomy which, reduces the breast envelope at the same time of mastectomy. The nipple can be preserved attached to his skin flap or grafted to its new position.

Benefits of Nipple Sparing Mastectomy

Some of the benefits of nipple sparing mastectomy include:

• Improves aesthetic outcomes
• Improves patient satisfaction
• Helps to preserve aesthetics of the nipple
• Helps to maintain breast shape and form
• Facilitate immediate breast reconstruction
• Facilitate one-stage breast reconstruction

Preparation for Nipple Sparing Mastectomy

In general, preparation for nipple sparing mastectomy may involve the following:

On the Day of Consultation:

• A thorough history taking and examination by Dr Meybodi is performed to check for any physical, medical and social circumstance. Address issues that need to be addressed prior to the procedure.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and more imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• Inform us of any medications, vitamins, or supplements that you are taking.
• You will review before and after surgery pictures of patients with similar breast size and shape who had Nipple Sparing Mastectomy.
• You will have a 3D photo to measure your other breast volume and shape for planning of your reconstruction.
• In some scenarios, the other breast also might need some procedures like a reduction or lift to achieve better symmetry. That will be discussed in the initial consultation.
• A written consent will be obtained from you after the procedure has been explained in detail, and you made your mind to proceed.

Preparation for the Surgery:

• Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing and increase your chances of areolar or nipple damage, tissue necrosis, and other complications.
• Maintain a moderated level of physical activity to enhance your physical and mental fitness in preparation for your surgery.
• You can find out more about how you prepare yourself and your home environment before surgery here.

On the Day of Surgery:

• You may be instructed to shower with an antibacterial soap in the morning of your surgery.
• You should not consume any solids and liquids 8 and 4 hours prior to surgery.
• You might need a lymphatic mapping the day before or on the same day of surgery.
• Please bring all your images to the operating theatre.

Procedure for Nipple Sparing Mastectomy

The procedure is usually performed under general anaesthesia. The incision is commonly placed on the breast fold. This incision is also used for access to the axillary nodes.

In all instances, the breast tissues are removed, leaving behind a natural skin pocket. The pocket may be immediately filled with your own body tissue or a breast implant, or a temporary tissue expander may be inserted, which maintains the space and size of the breast until breast reconstruction is performed. Detail of reconstruction has been explained on another page.

Post-Procedure Care and Recovery

Most patients can go home in a day or two after surgery if no complications are noted. The drains are usually removed in about a week or two following the surgery.

Post-procedure care and recovery has been discussed in detail on immediate reconstruction page.

Risks and Complications of Nipple Sparing Mastectomy

Nipple sparing mastectomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Pain or tenderness
• Poor tissue healing
• Swelling/bruising
• Scar formation
• Damage to blood vessels and nerves
• Hematoma (accumulation of blood in the wound)
• Seroma (accumulation of clear fluid in the wound)
• Surgical site infection
• Anaesthetic reactions
• Numbness, tingling, or itching sensations
• Nipple necrosis with meticulous anatomical dissection the risk of nipple and skin ischemia is extremely low with this procedure.