Nipple Sparing Mastectomy
Nipple Sparing Mastectomy
What is a Nipple-Sparing Mastectomy?
When a woman has a unilateral (single) mastectomy [Link to Unilateral Mastectomy] or a bilateral (double) mastectomy, [Link to Bilateral Mastectomy] she may have the option to retain the tissue of her nipple and areola (the dark skin around the nipple). In surgeries where most of the breast tissue is removed, usually together with most of the skin but the nipple is retained, it's known as a nipple-sparing mastectomy.
What are the Benefits of a Nipple-Sparing Mastectomy?
A mastectomy that keeps the nipple and areola has several benefits compared to traditional mastectomies, including:
- Improved Cosmetic Outcomes: By preserving the nipple and areola, a nipple-sparing mastectomy can result in a more natural-looking breast shape and appearance. This can help boost self-esteem and body image for many women undergoing breast cancer treatment.
- Preserves Sensation: Because the nerves responsible for sensation are left intact during a nipple-sparing mastectomy, there is a higher likelihood of retaining feeling in the breast area after surgery. This can help you keep sexual function and improve your overall quality of life after surgery.
- Easier Reconstruction Options: With the preserved nipple and areola, reconstructive surgeons have more flexibility in creating a natural-looking breast mound during reconstruction following this type of mastectomy. This can lead to better symmetry between breasts and improved overall aesthetic results.
- Psychological Benefits: Keeping the nipple and areola intact can help women feel more connected to their bodies post-mastectomy, reducing feelings of loss or disfigurement often associated with breast cancer surgery. Maintaining these physical features can also help with emotional healing and adjustment after treatment.
Who is a Good Candidate for a Nipple-Sparing Mastectomy?
In discussion with your surgeon, you will be able to consider whether it will be a possibility for you to keep some or all of your breast skin or your nipple. In some cases you will be able to retain some or all of the skin, and this is known as a skin-sparing mastectomy. [Link to Skin-Sparing Mastectomy] In this case, you may or may not be able to keep your nipple.
A nipple-sparing mastectomy is a good option in the following circumstances:
- Small Tumor: Nipple-sparing mastectomies are typically performed on women with small tumors that are not located near the nipple or areola. If the tumor is too close to these areas, it may not be possible to preserve them during surgery.
- No Cancer in the Area: It's important that there is no evidence of cancer involving the nipple or areola before considering a nipple-sparing mastectomy. If cancer cells are present in or near the area, they may need to be removed with the rest of the breast tissue.
- Women Having Immediate Reconstruction: Because the nipple, areola, and some skin will be preserved in this procedure, it is beneficial for women who choose to have a breast reconstruction [Link to Breast Reconstruction] immediately following mastectomy, during the same operation.
- Women without Inflammatory Breast Cancer: Inflammatory breast cancer involves rapidly growing tumors that cause redness and swelling of the skin. Due to its aggressive nature, patients with this type of cancer may not be suitable candidates for a nipple-sparing mastectomy.
- Nonsmokers: Smoking impairs wound healing and increases the risk of complications following surgery. Therefore, nonsmokers make better candidates for any type of surgical procedure, including nipple-sparing mastectomies.
- Good Overall Health: Like any major surgery, a nipple-sparing mastectomy carries some risk and requires a certain level of physical fitness to ensure proper healing and recovery. Candidates should be in good overall health without any underlying medical conditions that could complicate surgery.
Not all patients will be suitable candidates for this type of mastectomy. Factors such as tumor size, tumor location, and previous radiation therapy may affect your eligibility for this procedure. Ultimately, your suitability for a nipple-sparing mastectomy will depend on your individual circumstances, and consultation with your surgeon will determine whether it would be a good option in your case. It's essential to discuss all options thoroughly with your medical team before making any decisions about treatment plans.
What Should I Expect From My Surgery?
During a nipple-sparing mastectomy, the surgeon will remove the breast tissue from one or both sides of your chest, but they will retain the nipple and areola. Some or all of the skin may also be retained during this procedure, depending on the extent of the disease or your personal preference.
After undergoing the mastectomy, your surgeon will then complete the reconstructive surgery to restore the appearance of your breasts. The type of reconstruction will depend on your situation and the plans made in advance of your surgery.
Before Surgery
Before your surgery, you'll have a meeting with your surgical team to go over the details of your operation. This is a great opportunity to ask any questions you may have and ensure you fully understand the procedure, its purpose, associated risks, and any alternative treatments available.
It's important to consider whether you may need radiation therapy after your surgery, as it can affect your options for breast reconstruction. Some patients may know in advance that radiation will be part of their treatment plan, while for others, this decision may depend on the results of the mastectomy. You may have a consultation with a radiation oncologist before or after surgery to discuss the potential benefits and risks.
Your healthcare team will provide you with specific instructions to prepare for surgery, which may include:
- Informing your healthcare team about any medications, vitamins, or supplements you're currently taking, as certain substances may interfere with the surgery.
- Stopping certain medications, such as aspirin or other blood-thinners, as advised by your healthcare team.
- Following guidelines regarding fasting before surgery, which may involve refraining from eating for several hours beforehand and only drinking liquids up to a certain time.
- Planning for post-surgery arrangements, such as whether you'll need to stay in the hospital overnight or go home the same day. Arrange for transportation if you're discharged the same day and prepare a bag with essentials for your hospital stay, including toiletries and items for comfort and entertainment.
During Surgery (Procedure Overview)
A mastectomy of any type will normally involve staying in the hospital for at least one night, depending on the type of surgery you will be having. The procedure can vary based on your personal circumstances and your doctor's methods.
- You'll be asked to change into a gown.
- An IV (intravenous) line will be inserted into your arm or hand to give you medication that will help you relax and put you to sleep during surgery.
- You'll lie on your back on the operating table.
- Your vital signs, like heart rate and blood pressure, will be monitored throughout the surgery.
- The skin around the surgical area will be cleaned with a sterile solution and an incision will be made in the first breast. The type of cut will depend on the type of mastectomy you're having.
- The breast tissue will be carefully removed, retaining the nipple, the areola, and some or most of the skin.
- The lymph nodes are usually left intact with this type of mastectomy. However, if your surgeon has concerns about the extent of the cancer, they may do a sentinel lymph node biopsy at a later date.
- The same procedure will be repeated on the other side if you are having a double nipple-sparing mastectomy.
- Your surgeon will then reconstruct the shape of the breast using the technique agreed in advance of the mastectomy. Typically, reconstruction is by using implants following nipple-sparing mastectomies.
- The removed tissues will be sent to the hospital lab for examination.
- Drainage tubes may be inserted into the area.
- The incisions will be closed with stitches or adhesive strips and a sterile bandage or dressing will be applied over the site.
After Surgery & Recovery
During your hospital stay, you'll be taken to the recovery room after the procedure. There, you'll be closely monitored until your vital signs like blood pressure, pulse, and breathing are stable, and you're awake and alert. Once you're stable, you'll be moved to your hospital room.
Typically, you'll stay in the hospital for 1 to 3 days after a mastectomy, depending on the extent of the surgery and what type of breast reconstruction you have. Some reconstructions, such as TRAM flaps, require more extensive surgery and your stay in hospital could be up to a week.
Once you're home, it's important to keep the surgical area clean and dry, following your doctor's instructions. You'll also need to care for the drainage tubes, which are usually removed after about 2 weeks at your first follow-up exam.
You may experience some pain, which can vary depending on the surgery. Your healthcare team will recommend pain relievers, but be cautious about taking aspirin or certain other pain medicines that may increase the risk of bleeding.
You can typically resume normal activities in a few weeks, but you should avoid strenuous activities in the meantime. Your surgeon will advise you on when you can drive again and return to work.
If you're having difficulty coping with your recovery, you may find it helpful to speak to your loved ones or to join a support group for assistance. This can help you cope with the emotional aspects of undergoing this type of surgery.
Contact your doctor if you experience fever, chills, increased pain, swelling, or any other concerning symptoms after surgery.
Contact us today [Link to Contact] for a confidential conversation by video call directly with one of our expert surgeons. We are more than happy to discuss your treatment options with you if you have already had a cancer diagnosis or are at a high risk for contracting the disease.