Nipple/Areola Sparing Mastectomy

There seems to be some controversy out in the breast surgery world about Nipple/Areola Sparing Mastectomy.

I understand the basics of the procedure - that the nipple/areola complex will require a blood supply to remain viable, and that it isn't always feasible to do so. Also, that there may be a recurrence in that area for a small number of patients - BUT - that it will be easy to detect early as it will be so near the surface.

Some surgeons do not recommend them for any patient. They state that the cosmetic result would be inferior to a fake nipple/areola complex, and won't even consider it a possibility.

However, recent research I've encountered would appear to contradict that broad assumption.

I understand that every case is different, that many factors will contribute to any physician's recommendation and must be based on a clinical evaluation of the individual patient (there, I put in the caveats for you, already) - BUT - can you comment on this area and shed some light on the controversy?

Thank you very much for your time. Your contributions to this website are invaluable to the many of us out here that are seeking as much knowledge as we can glean.

[Cleveland Clinic]

Dear strike3:  Nipple sparing mastectomy is a viable option for a select group of women whose tumors physically lend themselves to safe resection while leaving adequate blood supply to the areolar complex.  It should only be considered in the hands of a very experienced breast surgeon.  We do this procedure at our institution but only a couple of surgeons and only in very select cases.

[Callygee]

I would have LOVED to have a nipple sparing mastx. I think they look great. My surgeon does them, but I may have a skin sparing mastx instead. He says NSM takes longer, and is more difficult for him to perform but that it can definitely be done successfully and he has done so. I already have a scar from previous lumpectomy, and hope to have a DIEP at the same time, so it's not good for me.

I am waiting to determine whether I will have mastx/DIEP same time or wait for delayed reconstruction. I will be having radiation after the mastx and my surgeon and I are checking on a few things before we make our final decision.

I'm learning that there are some health centers that are in the forefrunt of procedures and some that don't feel comfortable trying the newer procedures.

[ly3]

I had a nipple-sparing mastectomy in March 2004, and it was the best thing I could have done to help me recover from the shock of having to deal with this disease.  My tumor was far enough from the nipple for me to qualify.  Following a lumpectomy, I was diagnosed stage IIA in October 2003, had a re-excision, and still there was DCIS in the margins (multifocal disease).  Mastectomy was recommended by all, because of the multifocal factor, but they said I could do chemo first, and then decide between mast. or another lumpectomy, then radiation.  Once I began dealing with the difficulties of chemo, I realized I didn't want to ever have to do THAT again, and started leaning toward mastectomy followed by immediate TRAM flap.  I was still an emotional wreck when I went into surgery, but when I woke up, my "new" breast looked just like before (only bruised).  It was an outlook turning point for me.  From the front I look exactly the same.  The nipple is flatter, slightly less pink, and behaves differently than the other, but still contracts and has some limited feeling.  I do not have any regrets, and have thanked my doctors at the CC for caring enough to create this surgery.  I had been devastated, and had been told by my breast surgeon that I was going to be so much better once the surgery was over, and he was so right.  My mental recovery had everything to do with this procedure.  Now, I look back and marvel that I got through the trauma somehow.  Feel free to ask any questions, and good luck.  

[kathy146]

Hi, I'm wondering how you are feeling now with regards to your nipple-sparing surgery? I am having a bi-lateral mastectomy done next week, but we didn't discuss the possibility of saving the nipples! I would love to of course,,,now I want to call my surgeon Monday morning and ask WHY CAN'T We SAVE MY NIPPLES?! I don't think she has the experience...I'd have to find a new surgeon I think...it's taken me  four months to get from mammogram  to surgery date set!  I live in the Ventura area of California...?

[kathy146]

I live in California, half way between Santa Barbara and Los Angeles, in Ventura County. I'm having a bi-lateral mastectomy.I have early stage, small areas lobular carcinoma,and had a breast reduction 24 yearas ago(if that affects anything). I would be so much happier with a nipple-sparing mastectomy if possible. Any ideas for me? Thanks!

[MalindaCarolyn]

When Susan got her's, they formed a nipple looking thing on her breast. They said that saving the nipple would chance saving some cancer there. It looked good.

Don't hesitate to call your doctor and ask more questions. If she is not experienced enough to do this, then you should consider asking another surgeon.

[ly3]

You may have already had surgery by now but all the info about me is on my posts.  My multifocal ductal carcinoma and DCIS was on the outer side of my breast, more than 3" from the nipple.  The breast surgeon skeletonized the nipple, and the core was sent for a frozen section biopsy during surgery, to rule out cancer cells there.  If cancer was present there, they'd remove the nipple.  There wasn't, and following the mastectomy, I had a pedicle TRAM flap reconstruction.  Not every surgeon does this surgery and there are differing opinions about it.  My surgeons at the Cleveland Clinic pioneered their techniques, and I'm in a follow-up study.  The nipple is slightly less pink, contracts not always with the other, and does have limited sensation.  It looks just like it did before, and that was the catalyst to my emotional recovery.  Good Luck!

[fran1014]

A related discussion, Nipple sparing or areola sparing was started.