Nipple-Sparing Reconstruction: Is This Innovative Surgery Safe?

PJ Hamel Health Guide
  • Did you know that the mastectomy is an operation that’s hundreds of years old? Women were having mastectomies – breast removal – long before the advent of anesthesia, when the only thing a breast cancer sufferer could do was take a swig of brandy and bite down hard on her screams.

    Back then, surgery was a crude affair, the breast with its tumor carved off the chest with no thought for cosmetic appearance, muscle damage, or anything else. Those early 19th-century surgeons did the best they could – but it wasn’t good.

    Surprisingly, surgery remained fairly crude right up into the 1970s, with radical mastectomies robbing a woman not only of her entire breast and its skin, but the underlying muscle as well. A mastectomy could be crippling – and usually was.

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    Enter the modified radical mastectomy (affecting just the breast itself, with very little chest muscle), which introduced a new era in breast surgery. For the past 30 years, mastectomies have become more and more refined, to the point where a surgeon can now remove just the interior breast tissue and nipple – no muscle, no skin. Some surgeons are even able to leave the areola (the dark part around the nipple) intact, taking just the nipple itself.

    This so-called skin-sparing mastectomy, used in conjunction with reconstruction, has become commonplace. Now, there’s yet another new surgery, a twist on skin-sparing mastectomy, gradually making its way into the public. But while it yields tremendous cosmetic results, there’s controversy over how effective it is in preventing the spread of cancer.

    Nipple-sparing mastectomy leaves the entire outer “shell” of the breast intact; only interior tissue is removed. The surgeon removing the tumor and surrounding tissue works in conjunction with a plastic surgeon, who immediately replaces the excised breast tissue with an implant. So you come out of surgery with a new breast that looks much like your old one – same skin, same nipple.

    Sounds good, right? Well, there’s one problem: there’s a concentration of milk ducts in the area right around the nipple; and milk ducts are where most cancers take root and grow. Thus, many oncologists are saying it’s risky to leave that potential problem area intact, since it would seem to increase the risk of recurrence significantly.

    Studies done over the past 10 years show low rates of recurrence for nipple-sparing mastectomy; but some doctors argue that the studies have been too small, and the time window too short, to draw firm conclusions that this surgery is safe.

    So once again, as cancer survivors undergoing treatment, we’re in “should I or shouldn’t I” mode. Should I risk this partially proven surgery – or not?

    Consensus among doctors and oncologists currently is that nipple-sparing mastectomy is safe for three groups of patients:

    •Women with no sign of cancer, having a prophylactic double mastectomy due to a strong family history or the presence of one of the BRCA genes;
    •Women with small tumors located away from the nipple;

  • •Women with larger tumors, distant from the nipple, where biopsy results show that there’s little chance the tumor has already spread.

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    What are the advantages to nipple-sparing mastectomy, aside from cosmetic? It’s a shorter, less invasive surgery than the typical mastectomy/immediate reconstruction, lasting just 2 to 3 hours (compared to a typical 6- to 9-hour procedure). And the healing process is faster.

    Disadvantages? Well, sparing the nipple doesn’t save its sensation; same as a typical skin-sparing mastectomy, you won’t have any feeling there. And there’s the (perhaps) increased chance of a cancer recurrence.

    About 5% of women having a mastectomy are now choosing this new nipple-sparing option. If you think you’re a good candidate (and are willing to try a perhaps-not-quite-proven technique), ask your oncologist or surgeon about it. You may have to do some research to find a facility that performs this surgery; but if a shorter, less invasive surgery (and  great-looking breast) are important to you, it’s definitely worth checking out.

Published On: June 01, 2011