Nipple-Sparing Mastectomy

by Beth Anglin, M.D., FACS

Breast Exam2

Nipple-sparing mastectomy (NSM) is a possible option in the treatment or prevention of breast cancer. However, it is not the standard of care for either. The term “nipple-sparing mastectomy” should not be confused with the older term “subcutaneous mastectomy.” Subcutaneous mastectomies were used in the past for benign issues and were later found not to remove enough breast tissue for cancer therapy.

A nipple-sparing mastectomy combines oncologic safety with improved cosmetic outcome. NSM involves a more extensive removal of breast tissue than was carried out by the subcutaneous mastectomy. In comparison, a skin-sparing mastectomy preserves the breast skin but does not preserve the nipple. There are large series of skin-sparing mastectomies (SSM) that have been studied, suggesting that oncologic safety is the same as traditional mastectomy that removed most of the skin.

At this time, there are no large studies of NSM with sufficient follow-up to prove NSM is as safe as traditional mastectomy. To answer this question, the American Society of Breast Surgeons has begun a multi-institutional registry of women undergoing a NSM. This registry will cover information from cosmetic outcome to oncologic safety. The goal is to follow 1000 women.

Are you interested in this option? As an approved investigator for the study of nipple-sparing mastectomy in Plano, we can discuss any and all options. The study has also been approved by the IRB at The Medical Center of Plano. An IRB, or Institutional Review Board, is a group of physicians, lay people and religious representatives who make sure any study is safe and ethical.

Who is a candidate? As in any procedure, not everyone is a candidate. Since there are no long-term studies, guidelines are combined from many smaller studies.

1. Location: The tumor should be 2 cm or more from the nipple.

2. Size: The size of the cancer, either invasive or DCIS, should be less than 3-4cm. With larger tumors, studies show an increased chance of cancer in the ducts of the nipple.

3. Multifocal: If the cancer is in multiple areas in the breast, the risk of cancer in the nipple increases.

4. Breast size and shape: This can be a consideration to discuss with your breast surgeon and reconstructive surgeon.

What are the risks? Like in any surgery there are the uncommon risks of the procedure and anesthesia.

1. Nipple sensation: Some women have decreased or no sensation in the nipple after the surgery.

2. Nipple projection: By removing a sample of tissue beneath the nipple for testing, the nipple might be “‘flatter” than before surgery.

3. Nipple or skin loss: There is fine line between removing enough tissue for cancer treatment or prevention and leaving enough for blood supply and healing.

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