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Nipple Sparing Mastectomy
Everything You Need To Know Nipple Sparing Mastectomy
What is nipple sparing mastectomy?
Mastectomy is a surgical procedure in which one or both breasts are removed to treat or prevent the spread of breast cancer. Nipple sparing mastectomy is a type of mastectomy that involves the removal of breast tissue without removing the nipple, areola, and breast skin. The primary objective of the modern Nipple sparing mastectomy is to remove all cancerous or cancer-risk breast tissue while preserving the nipple-areolar complex (NAC) and skin covering along with its blood supply.
This surgical procedure has acquired popularity and the reputation of being a safe treatment option with a low risk of cancer recurrence for patients with breast cancer. Nipple sparing mastectomy is followed by immediate breast reconstruction providing good, natural-looking breasts with minimal scarring. The success rate after nipple sparing mastectomy and breast reconstruction has increased from 88% to 100%.
Who is a suitable candidate for nipple sparing mastectomy?
Nipple sparing mastectomy is recommended for patients who want to keep their original breast’s size, and shape, and have minor ptosis (breast droopiness). This procedure is usually performed in breast cancer when the malignancy does not affect the nipple or tissue under the areola. Nipple sparing mastectomy is ideal for women who are willing to undergo risk-reduction prophylactic surgery, such as BRCA1 and BRCA2 defective gene carriers. Additionally, it can also be used for the treatment of early-stage breast cancer and for the treatment of large tumours that are not suitable for lumpectomy.
Preparation for nipple sparing mastectomy
On the day of consultation, the healthcare provider will take a complete history and physical examination to rule out any physical, medical, and social conditions that need to be addressed before the procedure. Patients may need to undergo blood and imaging tests to help detect any abnormalities that could interfere with the safety of the treatment. The oncologist should be informed of any allergies the patient may have, as well as any medications/supplements the patient is taking. Additionally, the patient should fast for 4-8 hours on the day of surgery.
Procedure for nipple sparing mastectomy
Nipple sparing mastectomy is usually carried out under general anaesthesia. The incision starts from the breastfold. The breast tissue is removed, leaving a natural skin pocket. A temporary tissue expander may be placed, maintaining the space and size of the breast until breast reconstruction is carried out, or the pocket may be promptly filled with body tissue or breast implant.
Post-procedure care and recovery for nipple sparing mastectomy
The majority of patients are able to return to their homes within a few days following the procedure, provided there are no reported complications. Pain and swelling may occur after the procedure, but they can be managed with medications. Most women are able to resume their normal activities within 4 to 6 weeks. During the recovery period, it is essential to eat healthy and abstain from strenuous physical activity. Follow-up visits with the surgeon are recommended.
Risks and complications of nipple sparing mastectomy
Nipple sparing mastectomy is a relatively safe procedure, but there are some potential risks to consider, such as:
- Pain or tenderness
- Poor tissue healing
- Swelling
- Formation of scars
- Blood vessel and nerve damage
- Hematoma
- Surgical site infection
- Anaesthetic reactions
- Numbness, tingling, or itching sensation
- Nipple necrosis
FAQs
Patients with large, centrally located, and/or aggressive tumours are typically not eligible for a nipple sparing mastectomy. Additionally, this procedure is not recommended for patients with diabetes, those who smoke, or those who have a history of poor post-operative healing.
Around 30% to 60% of patients who had the procedure experienced sensation in their nipples, particularly over a period of time. This is not the case for a reconstructed nipple. The surgeons who perform the procedure typically advise patients that it will take six to twelve months after surgery for sensation – and, in some cases, erectile function – to return.
In terms of breast cancer prevention and treatment, nipple sparing mastectomy is very effective. However, it is important to note that this procedure is not suitable for all breast cancer patients. There are certain criteria that must be met in order to select a patient for this procedure.
Breast cosmesis is one of the most important aspects of a nipple sparing mastectomy. The breast appears virtually undamaged with only a slight scar visible in the under fold of the breast (known as the inframammary fold) or extending outward towards the arm. Otherwise, the breast appears intact.
Nipple sparing mastectomy do not increase the risk of recurrence of breast cancer compared to standard surgery. According to a recent study published in Plastic and Reconstructive Surgery, the rate of recurrence is low (3%) up to 10 years post nipple sparing mastectomy.
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What is nipple sparing mastectomy?
Mastectomy is a surgical procedure in which one or both breasts are removed to treat or prevent the spread of breast cancer. Nipple sparing mastectomy is a type of mastectomy that involves the removal of breast tissue without removing the nipple, areola, and breast skin. The primary objective of the modern Nipple sparing mastectomy is to remove all cancerous or cancer-risk breast tissue while preserving the nipple-areolar complex (NAC) and skin covering along with its blood supply.
This surgical procedure has acquired popularity and the reputation of being a safe treatment option with a low risk of cancer recurrence for patients with breast cancer. Nipple sparing mastectomy is followed by immediate breast reconstruction providing good, natural-looking breasts with minimal scarring. The success rate after nipple sparing mastectomy and breast reconstruction has increased from 88% to 100%.
Who is a suitable candidate for nipple sparing mastectomy?
Nipple sparing mastectomy is recommended for patients who want to keep their original breast’s size, and shape, and have minor ptosis (breast droopiness). This procedure is usually performed in breast cancer when the malignancy does not affect the nipple or tissue under the areola. Nipple sparing mastectomy is ideal for women who are willing to undergo risk-reduction prophylactic surgery, such as BRCA1 and BRCA2 defective gene carriers. Additionally, it can also be used for the treatment of early-stage breast cancer and for the treatment of large tumours that are not suitable for lumpectomy.
Preparation for nipple sparing mastectomy
On the day of consultation, the healthcare provider will take a complete history and physical examination to rule out any physical, medical, and social conditions that need to be addressed before the procedure. Patients may need to undergo blood and imaging tests to help detect any abnormalities that could interfere with the safety of the treatment. The oncologist should be informed of any allergies the patient may have, as well as any medications/supplements the patient is taking. Additionally, the patient should fast for 4-8 hours on the day of surgery.
Procedure for nipple sparing mastectomy
Nipple sparing mastectomy is usually carried out under general anaesthesia. The incision starts from the breastfold. The breast tissue is removed, leaving a natural skin pocket. A temporary tissue expander may be placed, maintaining the space and size of the breast until breast reconstruction is carried out, or the pocket may be promptly filled with body tissue or breast implant.
Post-procedure care and recovery for nipple sparing mastectomy
The majority of patients are able to return to their homes within a few days following the procedure, provided there are no reported complications. Pain and swelling may occur after the procedure, but they can be managed with medications. Most women are able to resume their normal activities within 4 to 6 weeks. During the recovery period, it is essential to eat healthy and abstain from strenuous physical activity. Follow-up visits with the surgeon are recommended.
Risks and complications of nipple sparing mastectomy
Nipple sparing mastectomy is a relatively safe procedure, but there are some potential risks to consider, such as:
- Pain or tenderness
- Poor tissue healing
- Swelling
- Formation of scars
- Blood vessel and nerve damage
- Hematoma
- Surgical site infection
- Anaesthetic reactions
- Numbness, tingling, or itching sensation
- Nipple necrosis
FAQs
1. When is it not advisable to undergo a nipple sparing mastectomy?
Patients with large, centrally located, and/or aggressive tumours are typically not eligible for a nipple sparing mastectomy. Additionally, this procedure is not recommended for patients with diabetes, those who smoke, or those who have a history of poor post-operative healing.
2. Is it possible for the nipple to experience sensation after a nipple sparing mastectomy?
Around 30% to 60% of patients who had the procedure experienced sensation in their nipples, particularly over a period of time. This is not the case for a reconstructed nipple. The surgeons who perform the procedure typically advise patients that it will take six to twelve months after surgery for sensation – and, in some cases, erectile function – to return.
3. Can breast cancer be treated and prevented with a nipple sparing mastectomy?
In terms of breast cancer prevention and treatment, nipple sparing mastectomy is very effective. However, it is important to note that this procedure is not suitable for all breast cancer patients. There are certain criteria that must be met in order to select a patient for this procedure.
4. What are the advantages of a nipple sparing mastectomy?
Breast cosmesis is one of the most important aspects of a nipple sparing mastectomy. The breast appears virtually undamaged with only a slight scar visible in the under fold of the breast (known as the inframammary fold) or extending outward towards the arm. Otherwise, the breast appears intact.
5. Does nipple sparing mastectomy increase the risk of breast cancer recurrence?
Nipple sparing mastectomy do not increase the risk of recurrence of breast cancer compared to standard surgery. According to a recent study published in Plastic and Reconstructive Surgery, the rate of recurrence is low (3%) up to 10 years post nipple sparing mastectomy.
References:
1. Nipple-Sparing Mastectomy. Cedar Sinai. https://www.cedars-sinai.org/health-library/diseases-and-conditions/n/nipple-sparing-mastectomy.html#:~:text=A%20nipple%2Dsparing%20mastectomy%20leaves,tissue%20just%20underneath%20the%20nipple.
2. Types of Mastectomy. Breast Cancer. https://www.breastcancer.org/treatment/surgery/mastectomy/types.
3. FAQs about Nipple-Sparing Mastectomy. Renaissance School of Medicine.
https://renaissance.stonybrookmedicine.edu/surgery/patient-care/clinical/breast-surgery/patient-education/faqs-about-nipple-sparing-mastectomy.
4. Mastectomy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/mastectomy/about/pac-20394670.