Breast cancer treatment and prevention by mastectomy has evolved from the disfiguring radical mastectomy to the "Nipple Sparing Mastectomy." (NSM) In this procedure, the entire skin envelop, including the nipple-areola complex (NAC,) is preserved, while all of the glandular breast tissue is removed. This reduced disfigurement makes subsequent breast reconstruction simpler and more appealing.
Nipple-sparing mastectomy is based on extensive research that shows there is no increased risk of cancer recurrence, when the procedure is preformed on appropriately selected patients. Patients may not be good candidates for NSM if:
1. The tumor is near the nipple;
2. The tumor involves the skin extensively, as in inflammatory breast cancer;
3. The breast is large and/or the nipple is below the breast fold;
4. There are previous incisions around the NAC, which can diminish blood flow to the nipple.
Nipple-sparing mastectomy is usually done either through an incision in the fold underneath the breast or through an incision around the bottom half of the areola. The latter excision may need to be extended on the outer aspect of the breast to give the breast surgeon enough room to work. After the breast tissue is removed, the plastic surgeon can proceed with breast reconstruction as they would otherwise, only now there is one less part of the breast to replace.
Postoperatively, patients frequently develop discoloration and blistering of the NAC. However, complete loss the the NAC is uncommon. When it does happen, it could require a separate surgery to excise it. Though NSM is a great improvement, it is important to recognize its short comings. Sensation is permanently absent in 100% of patients following the procedure. Likewise, because there is no longer any breast tissue beneath the nipple, breast feeding after is not possible. These last two factors may be more important to women with a genetic predisposition to breast cancer (BRCA 1 & 2) who are considering preventative surgery.
Nipple-sparing mastectomy can make the treatment and prevention of breast cancer less intimidating and allow your reconstructed breast to look more like your own. Please ask your doctor if this procedure is right for you.