If you are diagnosed with cancer and facing a mastectomy, you will undoubtedly want to become informed about various options for your surgery. Likewise if you are cancer-free currently but meet the criteria for genetic predisposition, you might be facing the same choices as you consider a prophylactic mastectomy.
At Orlando Cosmetic Surgery, we see a growing popularity for such options as mastectomy with immediate re-construction, in cases of cancer or predisposition. In such cases, your plastic surgeon works alongside your breast cancer surgeon during your surgery.
Likewise, in some cases, the Nipple-sparing (subcutaneous) Mastectomy with immediate reconstruction is an option. A new buzz about nipple sparing mastectomy has been generated recently because it was the choice made by celebrity Angelina Jolie.
What Is Meant By Nipple Sparing?
By definition, Mayo Clinic states, “A nipple-sparing mastectomy involves removal of only breast tissue, sparing the skin, nipple and areola. A sentinel lymph node biopsy also may be done. Breast reconstruction is performed immediately afterward.”
Dr. Scott Spear, known as the savior of one million nipples, and a pioneer in the field of nipple-sparing mastectomy, stated, “It’s similar to the architectural concept of historic preservation where architects will remove the inside of the building, but keep the façade.”
He explains saving the natural nipple is important to many women. “When a woman faces a mastectomy, she is often equally or more upset about losing what is visible, not just the inside of the breast.” He adds, “Women who have nipple-sparing mastectomies are psychologically better off, in terms of self-esteem and sense of self, than those who have had the nipple removed.”
In some cases such as Jolie’s, a small preliminary surgery is done about two weeks before the actual mastectomy. You might have heard of this and be curious about this procedure, so we will give you a little background on it:
Before Nipple Sparing: What is A Nipple Delay?
Termed a Nipple Delay, the surgery proceeds like this:
1. The surgeon uses the planned mastectomy incision and lifts half of the skin off of the breast surface.
2. “A small disc of the tissue directly behind the nipple and areola is also removed and analyzed by a pathologist. This is done to rule out the presence of any disease directly behind the nipples, which would make preserving them a dangerous proposition.”
3. Other than preservation of the nipple, another attractive benefit of this procedure is that “Some blood vessels are severed in removing that tissue, so that the nipple becomes accustomed to getting a majority of its blood supply from the surrounding skin.”
The function of the Nipple Delay is simply to ensure the nipple’s survival.
Dr. Joshua Levine, chief of surgical services at the New York Center for the Advancement of Breast Reconstruction, states this surgery “reduces the risk of having the nipple slowly die, in which case it would turn black and have to be removed.” According to Levine, the nipple either dies or survives within two or three days of the procedure.
Neither the nipple sparing mastectomy nor the nipple delay are good procedures for women with large breasts and ptosis or women with large tumors. Women who have smaller breast or cancer, that is not located near the nipple, are considered good risks. Thus, “the procedure is dependent on several factors, including the size of the cancer, the size of the breast and the location of the cancer within the breast.”
Temporary Tissue Expanders
In some cases, when radiation therapy is needed after surgery, temporary tissue expanders are placed behind the chest wall muscle. One option for breast reconstruction involves placing temporary tissue expanders behind the chest wall muscle. These temporary expanders create form and shape to the breast mound.
This procedure allows a woman to “delay final breast reconstruction until after radiation therapy.
Orlando Cosmetic Surgery advises, “If you’re planning to have radiation therapy after surgery, meet with a radiation oncologist before surgery to discuss benefits and risks, as well as how radiation will impact your breast reconstruction options.”
Nipple Sparing Concerns
The first and most major concern with nipple sparing mastectomy would be “the potential for cancer recurrence in the future.”
With that in mind, researchers reviewed 169 NSM surgeries performed over 20 years at Georgetown
University Hospital.” Happily they discovered there were no cancer recurrences over the 2 and a half year follow-up.
The second major concern with breast-sparing mastectomy has been that the nipples were only cosmetic, and no longer had sensation.
However in recent years patients have reported, varying degrees of sensation.
“Some women — up to 30% to 60%, depending on the particular study — report sensation in the nipple, especially over time.”
Ultimately, the decision to have a nipple sparing mastectomy with immediate breast reconstruction is between you and your doctors. This article was intended to simply equip you with some of the preliminary facts behind the procedure so you could begin your quest to make informed decisions. Only you and your doctor can know what is right for you!