What is Nipple Sparing Mastectomy?
Nipple Sparing Mastectomy (NSM) is a surgical advancement for women undergoing removal of the breast due to breast cancer or as a preventative measure known as risk reduction surgery. Through a small incision, all of the breast glandular tissue is removed from beneath the overlying skin and nipple. The full breast skin envelope and nipple are left completely intact.
Reconstruction of the breast is completed at the same time with either an implant or natural tissue. This provides the potential for the ultimate refinement and, “untouched” look after mastectomy. Nipple Sparing Mastectomy may be regarded as the modern “gold standard” with respect to beautiful outcomes following complete mastectomy and immediate reconstruction.
Nipple Sparing Mastectomy is an extension of the more commonly known “skin-sparing mastectomy.” The goal of NSM is the preservation of structure and form of the breast without increasing risk or compromising the success of cancer treatment.
Nipple Sparing Mastectomy is the next step forward in the understanding of what should be removed at the time of mastectomy and what may be left unharmed. Much research has demonstrated the safety of NSM and its effectiveness for the treatment of breast cancer and risk reduction mastectomy procedures.
The same knowledge that popularized lumpectomy now propels Nipple Sparing Mastectomy to the forefront of breast cancer care. When combined with highly sophisticated breast reconstruction and the demand for high-quality, beautiful outcomes, it is clear why NSM continues to increase in popularity. The use of less invasive, muscle-preserving reconstructive techniques such as the DIEP and SGAP procedures have allowed hospitalization and recovery times to be reduced as well. The result is an overall superior treatment protocol and better long-term outcomes.
Only the most highly trained and experienced Breast Surgical Oncologists are able to reliably perform Nipple Sparing Mastectomy with high overall success rates.
When is Nipple Sparing Mastectomy Used?
Nipple Sparing Mastectomy has emerged as an alternative choice to lumpectomy/radiation for women with breast cancer who want to preserve a natural looking breast and avoid the risks that are associated with radiation treatment. While not all women will side-step radiation with nipple sparing mastectomy, the great majority will. This is supported by statistics that show nearly 70% of the 300,000 new breast cancer cases diagnosed annually in the U.S. present with early stage disease that may not require radiation after complete mastectomy.
All women with breast cancer who make the choice for lumpectomy require radiation as a part of lumpectomy treatment process. The opportunity to avoid the side effects on the chest wall, lung, and heart that come with radiation treatment is a significant potential advantage of Nipple Sparing Mastectomy. The added potential reduction in the risk of Lymphedema compared to lumpectomy/radiation is also a tremendous benefit to consider in cases where NSM can clear the disease and leave radiation unnecessary.
Nipple Sparing mastectomy is also appropriate for women seeking risk reduction preventive (“prophylactic“) mastectomy as in the case of a BRCA gene mutation.
Nipple Sparing mastectomy is possible in small and large breasts. It is generally appropriate when combined with either an implant or natural tissue reconstruction. Those with significant breast sagging (“ptosis“) are also candidates for a Nipple Sparing Mastectomy when combined with an immediate living tissue reconstruction such as the DIEP and SGAP breast reconstruction procedures. This important step forward was pioneered at The Center for Restorative breast surgery in 2015 and published in the Journal of Plastic Surgery. The American Society of Plastic Surgeons selected this article as one of the three studies highlighted in a video feature presented on the ASPS website showcasing the article as an informative, clinical, and applicable evidence-based study showing the power of peer-reviewed plastic surgery science and clinical research.
This progress allows for a full breast lift or breast reduction after nipple sparing mastectomy. The technology that makes this possible means that women who were previously denied preservation of their nipple at the time of mastectomy no longer have to be excluded due to pre-existing poor nipple position or breast size. This advancement has the capacity to produce results that were previously unachievable leaving better breast appearance after mastectomy than before. An important point to note for women seeking NSM with associated breast droop is that this modification of NSM is only possible when combined with a natural living tissue reconstruction. This represents a significant potential advantage of flap-based breast reconstruction over implant reconstruction in women who may benefit from a breast lift or breast reduction, and who also desire Nipple Sparing Mastectomy.
What are the Benefits of Nipple Sparing Mastectomy?
There are several benefits of Nipple Sparing Mastectomy and immediate breast reconstruction. The preservation of the natural nipple can produce a result that is nearly untouched in appearance. The minimization of scarring and creation of a fully natural look after mastectomy is a substantial evolution in breast cancer care and BRCA gene positive risk reduction surgery.
Even women with large breasts who would like to reduce their breast size or those with significant droop and sag in the breasts can now benefit from Nipple Sparing Mastectomy thanks to the pioneering work at The Center for Restorative Breast Surgery.
For women considering lumpectomy, Nipple Sparing Mastectomy provides another option to preserve structure and breast form. The added potential benefit of avoiding radiation treatment makes NSM worth considering over lumpectomy. The likely reduced risk of lymphedema, particularly when NSM is combined with natural tissue reconstruction, is a notable potential benefit of NSM over lumpectomy/radiation protocols that is only now being addressed as a significant long-term quality of life issue.
The advances pioneered at The Center for Restorative Breast Surgery give sophisticated solutions to women affected by breast cancer.
What are the Risks of Nipple Sparing Mastectomy?
There is a risk that the nipple tissue can heal poorly, although the track record at The Center for Restorative Breast Surgery is very good. Our published work has demonstrated this extensively. As with any surgery, the risks of surgery can be minimized by carefully following your pre-surgical instructions. If you have other medical problems or factors that increase your risk, we will work with you to educate you on proper preparation and arrange your clinical care regimen to maximize your safety and proper recovery.
What to Expect Throughout the Nipple Sparing Mastectomy Procedure
PRE-SURGERY OFFICE VISIT
In most cases, you will be seen in our office 1-2 days prior to your surgery. At that time, we will go over the planned procedure, review consents, answer any questions you may have, and apply any surgical planning markings as may be required.
The Nipple Sparing Mastectomy Operation
When you arrive at the hospital, you will be escorted to the preoperative holding area where you will change into a gown and be given foot coverings. The nurse or anesthesiologist will start an IV so that fluids and necessary medications may be given to you. Family members will be allowed to visit with you in the preoperative area once you are prepared for surgery.
After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant at your side. You will be carefully monitored and kept comfortable. You will then be transferred to a private inpatient room that is prepared to allow you to rest and recover under the supervision of your attending physician and nurses. One adult caregiver may stay with you overnight during your hospitalization. A fold-out Murphy bed has been integrated into your room for their individualized comfort.
Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital that has been recognized by the American College of Surgeons for Excellence in care quality. Highly trained professionals using the most modern equipment and techniques will attend to you. In addition to your surgeons, the surgical team includes anesthesiologists, operating room technicians, nurses, and physician assistants.
Post Nipple Sparing Mastectomy Operation
You will experience some changes that are quite common after surgery and may include:
Some mild swelling and bruising is to be expected after surgery and will gradually subside in a few weeks.
Some soreness is normal after surgery but we will provide medications to maximize your comfort and help speed your recovery. Intermittent muscle spasms and feelings of tightness are normal and will subside as your swelling subsides.
Scar lines tend to improve in appearance for up to a year and are usually faded by 12-18 months.
Some numbness in the skin is normal after surgery. Numbness in the preserved nipple is also typical but usually responds to temperature and touch remain. There is to be expected some progressive return of sensation over 12-18 months after surgery and the amount varies patient to patient. Occasionally the recovery of sensory nerves can result in tingling, itching, or mild electrical sensations that come and go. These sensations will resolve over time and are usually accompanied by some return of sensation as noted.
You may resume your normal activities as recommended by your surgeon. In most cases, avoidance of strenuous activity is recommended for 4-6 weeks. As a general rule, most patients can drive between 2-3 weeks after surgery if you are no longer using pain medication and your doctor has cleared you. It is recommended to perform gentle stretches for the shoulders beginning in the early weeks after your procedure. Your clinic team can provide specific instruction for a post-mastectomy range of motion exercises as applicable. You should maintain the full range of motion within the early weeks post-operation. Patients are generally released to return to full activities and work schedule between 4-6 weeks after surgery. Your clinic team will provide any necessary documentation for your employer.
Returning Home Post Operation
If you are traveling from out of state or internationally for care with us, your caregiver will need to be with you throughout your stay post-discharge and on the same flight home to assist you in the airport. Your caregiver’s education will be provided by our nursing staff during your time with us and our team is available to you and your assistant 24 hours/day should any questions arise after you are released from the hospital. Your arrangements for assistance after surgery should include an estimated seven to ten days of availability from your caregiver.
The Team at Center for Restorative Breast Surgery is Here for You
Be reassured that you are being attended to by some of the most highly skilled and dedicated healthcare providers in the world. Do your best to relax knowing that we are going to take excellent care of you from the moment you enter our facility. Do not hesitate to ask for any special needs you may have.