What is a Nipple Sparing Mastectomy?

Nipple-sparing mastectomy (NSM) is a surgical procedure that uses a small incision to remove glandular tissue of the breast from beneath the overlying skin and nipple, leaving the full breast skin envelope and nipple are left intact. The goal of NSM is to preserve the structure and form of the breast without increasing the risk of compromising the success of the cancer treatment. It requires additional attention to the blood supply and surgical skills to be done well and allow for optimal reconstruction.

Once breast reconstruction is completed with an implant or natural tissue (a procedure often performed at the same time as the mastectomy), the final breast appearance achieved is more of an “untouched” look.

When Is Nipple Sparing Mastectomy Performed?

NSM is an effective alternate choice to a lumpectomy and radiation treatment for women who would like to preserve a more natural-looking breast while avoiding the risks that come with radiation. It can also be an option in most patients who need a mastectomy but prefer to preserve the nipple. This can be safely done, without increasing the risk of breast cancer, in a number of patients.

Not all women will be able to avoid radiation treatment with NSM, but the great majority will, as nearly 70% of new breast cancer cases in the U.S. are diagnosed in the early stages of the disease. In many cases, this means they may not require radiation after a complete mastectomy.

Women with BRCA gene mutation who are seeking a risk reduction preventive (“prophylactic“) mastectomy can choose to benefit from NSM. Without an active cancer diagnosis, there is no reason the nipple cannot be preserved in the preventative setting. Many patients are often told they are “not a candidate” for nipple preservation due to the size or shape of their breasts. This is likely untrue as adjunct surgeries can be performed to make nipple preservation feasible and safe.

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What Happens During Nipple Sparing Mastectomy Surgery?

Nipple-sparing mastectomy is performed under general anesthesia. An incision is made on the underside of the breast in the natural crease known as the “Inframammary fold”. The doctor removes breast tissue through the incision. The doctor may also remove underarm lymph nodes to check for the spread of cancer.

The tissue under the nipple will be tested. If cancer is present, they may need to remove the nipple with or without the areola. 

Dr. Srinivasa will then work with your doctor to reconstruct your breast. She will perform either an implant reconstruction or use your own tissue avoiding the implant altogether (known as autologous reconstruction). In many cases, fat transfer may be combined to achieve ideal results. 

Dr. Srinivasa aims to avoid expanders whenever possible and specializes in the Prepectoral (above the muscle) Direct-to-Implant technique. This allows for a single staged reconstruction simultaneously as the mastectomies. Patients avoid the painful expanders and multiple visits to the office for fluid fills. Oftentimes revisions are needed to optimize the result.

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Candidates For Nipple Sparing Mastectomy

NSM is a huge step forward as the procedure is more available for a broader range of patients with varying concerns. 

  • Women with large or small breasts are candidates for NSM. 
  • Women with significant breast sagging are candidates for NSM as well, although a lift may be needed upfront. This can be combined with a cancer removal operation.
  • NSM is also appropriate for women who have a pre-existing poor nipple position.  

Generally, candidates for NSM should meet the following criteria:

  • Have no other serious medical conditions
  • Do not smoke
  • NSM will be combined with either an implant or natural tissue reconstruction
  • Understand the procedure and have realistic expectations for what it can achieve

Recovery After Nipple Sparing Mastectomy

Some patients spend one night in the hospital after their mastectomy procedure. Sometimes, patients can return home the same day as their procedure. Expect bruising and swelling during your recovery period, which will begin to ease after about one week. You will have drains (thin tubes installed at the surgical site that drain fluids away) in place. These will be removed within two weeks of your surgery.

Because breast reconstruction is performed at the same time as a nipple-sparing mastectomy, recovery may take longer than the period a traditional mastectomy without reconstruction requires. However, the benefit is that two surgical procedures are not necessary.

Full recovery after nipple-sparing mastectomy generally takes 1-2 months, depending on your age and general health. Once you are fully recovered, you will be able to resume your activity level before surgery.

What Are The Risks Of Nipple Sparing Mastectomy?

Like any surgical procedure, NSM carries risks such as bleeding, scarring, infection, loss of sensation, and others. NSM has a risk of the nipple tissue healing poorly, although when this procedure is performed by an experienced, knowledgeable specialist, the risk is greatly diminished.

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Why Choose Dr. Srinivasa For A Nipple Sparing Mastectomy?

Dr. Dhivya Srinivasa is a double board-certified plastic surgeon, fellowship trained in microsurgery. Dr. Srinivasa founded The Institute for Advanced Breast Reconstruction, where she specializes specifically in breast reconstruction following breast cancer and related procedures to help women put cancer fully behind them and confidently move forward with their lives. With her specialized training and background, she can offer the most advanced technology and techniques in implant and microsurgical procedures. Dr. Srinivasa performs over 200 breast flap reconstruction procedures every year. She is one of a select few practitioners who specialize in this highly advanced field of breast reconstruction, achieving successful, beautiful outcomes for her many patients.

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