Breast reconstruction after nipple-sparing mastectomy preserves the natural look of the breasts

A promising new trend in plastic surgery is breast reconstruction after nipple-sparing mastectomy. This option, while not appropriate for every patient, can:

• Keep the nipple and areola in place
• Preserve the natural look of the breasts
• In some cases, retain a degree of nipple sensation

“After nipple-sparing mastectomy and reconstruction, some women actually have a better shape to their breasts than they had before,” says Dr. Rappaport.

“There are a lot of psychological aspects surrounding mastectomy, in terms of losing the breast, losing shape, losing sensitivity of the nipple-areola complex,” Dr. Rappaport acknowledges. “Women are especially concerned with the loss of the nipple-areola complex, which basically is the largest deformity.”

Nipple-sparing mastectomy and reconstruction offer women a new option

“There's a promising trend: nipple-areola conservation in preventive and therapeutic mastectomy, with replacement of the breast mound itself, but sparing the anatomical landmarks of the breast,” Dr. Rappaport explains.

Dr. Rappaport answers questions about nipple-sparing mastectomy and reconstruction

Who is a candidate for nipple-sparing mastectomy and reconstruction?

“There are certain criteria you need to meet for nipple-sparing reconstruction. Factors that must be considered include the tumor, its location and the distance from the nipple-areola complex. Cancer treatment requires a team approach, and a lot has to do with the philosophy of the general surgeon and the breast tumor board you're working with.

“But, given an appropriate team approach, there is a possibility of being able to preserve the anatomical landmarks of the breast rather than just replacing the breast mound itself.”

What happens if there are cancer cells in the nipple or areola?

“There is a risk of residual tumor, but you can always go back and remove the nipple and areola if necessary. In that case, the nipple-sparing mastectomy will have saved a significant amount of skin, which then makes reconstructive surgery that much easier.”

What are the chances of residual cancer in the nipple or areola?

“Nipple-areola-sparing procedures have been shown to be a very reasonable, very safe procedure for preventive mastectomies in BRCA patients. In patients who actually have tumors, the incidence of occult tumors remaining in the nipple after the biopsy is less than 4%, given certain criteria, such as that the tumor is at least two centimeters away from the nipple and it is a small tumor. Not everybody is a candidate.”

What other factors determine who is a candidate for nipple-sparing reconstruction?

“Women with large or sagging breasts may not be considered good candidates for nipple-sparing breast reconstruction. In that situation, the nipple-areola complex can be harvested and reapplied as a graft. This gives a good visual effect, but the patient will lose sensation in the nipple and areola.

“It depends on where the tumor is. If it's in the lower half of the breast, it's a very straightforward procedure. If a woman has a tumor in the upper half of the breast, it becomes a little more difficult. But given that a woman has a sufficient volume of breast tissue—a C or D cup—there should be adequate tissue to be able to mobilize tissue and have a reasonably shaped breast.”

For more information about nipple-sparing mastectomy and reconstruction, visit the Breast Preservation Foundation's web site at www.breastpreservationfoundation.org