Nipple-sparing mastectomy: an FAQ

We know what a mastectomy does, and we also know about its psychological effects. What you may not have considered is a treatment which removes tumours and potentially dangerous material, but leaves certain features – namely, the nipple – intact. So let us give you a (very brief) overview…

What is nipple-sparing mastectomy?

It’s a removal of the breast tissue, like a traditional mastectomy, but without removal of any of the skin – or the nipple and the areola. This results in the breast looking virtually unchanged and intact – albeit with less volume – with a small scar either in the undercrease of the breast, or out toward the arm. This isn’t a mere cosmetic procedure; many women who have undergone nipple-sparing mastectomy claim an improvement in self-esteem and self-body image, when compared to those who have undergone nipple reconstruction.

Is there still sensation in the nipple after the procedure?

It varies. According to a recent study, between 30% to 60% of women who had undergone the procedure reported a sensation in the nipple, especially over time. That, of course, is completely not possible with a reconstructed nipple. Surgeons who perform the procedure often advise that it will take between six months to a year after surgery before sensation – and in some cases, erectile function – returns.

Who are the best candidates for nipple-sparing mastectomy?

Surgeons report that patients with relatively small, non-aggressive tumours that are peripherally located in the breast and that are not aggressive are generally good candidates for nipple-sparing mastectomy. They also contend that smaller-breasted women are usually more suited to the procedure, and that non-smokers who do not suffer from diabetes are the optimum candidates. As with all cosmetic surgery, it’s treated as a case-by-case decision.

How safe is nipple-sparing mastectomy?

As safe as any other procedure, but there are certain specific risks. As all of the tissue behind the nipple is removed, there is a slight risk of an interruption of the blood supply to it, which may shut off the healing process and result in nipple loss. Furthermore, as you’ll be losing the breast tissue, the blood vessels which normally supply the area may not be good enough to keep the affected area healthy, resulting in skin flap neurosis – a condition which delays wound healing and can even result in the skin (and nipple) dying off.

Does nipple-sparing mastectomy increase the risk of cancer reoccurring?

It depends if the nipple contains any abnormalities or evidence of cancer. There will be an evaluation of the nipple and the issue at the core of it during the surgery, and if any abnormalities are discovered, it will be recommended that it be removed and a nipple reconstruction procedure will be advised. It should be pointed out that this is a relatively rare: the nipple area is the least likely to have a recurrence of cancer because when the procedure is performed properly, as much breast tissue as possible is removed from the area.

What should be my first step towards undergoing nipple-sparing mastectomy?

Our advice, as always, is to seek advice from an oncoplastic breast surgeon that can assess whether you’re an appropriate candidate for this breast conservation technique.