Nipple-Sparing Mastectomy: What is It?

What Is a Nipple-Sparing Mastectomy?

biopsyThe mastectomy procedure is one that most breast cancer patients undergo. This surgery has been around for centuries and it wasn’t until the past 30 years that this procedure has been refined, with the patient in mind.

A growing number of breast cancer patients have chosen to undergo reconstruction after a mastectomy. But what if you could undergo the mastectomy procedure while preserving your nipples and breast skin?

Breast Cancer Answers Medical Director Dr. Jay Harness explains the life-changing nipple-sparing mastectomy procedure and how you can better determine if you are eligible for this.


Jay K. Harness:  Nipple sparing mastectomy, who is eligible for nipple sparing mastectomy, there is a growing interest in this option of doing mastectomies.  Let me explain what I believe the options are.

Nipple sparing mastectomy, what is it?  Well, it means saving all of the skin of the breast, you could possibly remove just a little bit of skin, may be where the tumor is seen right underneath, but in general, we are talking about saving whole of the skin, we are talking about saving the nipple areolar area.  So, when I am asked by patients, am I eligible for this and what are the criteria for doing nipple sparing mastectomies? 

I can share with you, there is no universal criteria, there is not a universal acceptance of all of us in the field of who is a good candidate and who is not.  There are several absolute contraindications, there are times you should absolutely not have a nipple sparing mastectomy.  Of course, one of those is if the nipple and areolar area are already involved by the cancer.

Another contraindication is a super-aggressive kind of breast cancer called inflammatory breast cancer.  Most of us feel that is not a good idea either.  After that, it varies from institution to institution and hopefully over the next few years, there will be a greater consensus involving all of us about who is a good candidate.

Some of my colleagues feel that if the breast is too big and drooping too much then it is too difficult to try and do a nipple sparing mastectomy and that is a contraindication.  Unfortunately, with the plastic surgeons that I work with, we have overcome that and come up with some newer techniques for the large D or DD that is drooping too much.

There are other times where the breast is way-way too small, can be reconstructed and expanded, the answer is yes.  One of the benefits has been that I am slightly I am going to say this for my smaller breasted patients, Dr. Harness can I be bigger if we are doing nipple sparing mastectomy, the answer is yes, you can because at the time of doing the mastectomy, we put in what is called a tissue expander that overtime expands things up.

Now, here is something that is really critical.  We don’t want this side looking good and the other side drooping, okay.  So, therefore if you have a mastectomy on one side, nipple or not, you have a legal right to have the other side look good and made symmetrical and that is really very-very important and thank goodness, we have these kind of statues on the …, so that you will end up coming whole out of the whole process.  Nipple sparing mastectomy is gaining greater and greater acceptance and by and large, the cosmetic results can be great.  One important thing is you can feel is sensation but nobody can recreate a nipple areola as well as the real thing.