Nipple Sparing Mastectomy
We all know that mastectomy involves removal of the entire breast tissue along with as much as possible the overlying skin. Further Skin sparing mastectomy is where the breast tissue is removed while retaining as much skin as possible. An extension of the Skin sparing mastectomy is while significant portion of overlying skin is retained, further the Nipple and aereola is also retained. The end result of the surgery is an almost normal looking breast is reconstructed while completely removing the cancer tissue along with remaining breast tissue.
This type of breast cancer surgery is advised in select patients who meet strict criteria to ensure equal cure rates as in Mastectomy. The disease is often done in those patients who have large tumors or multiple tumors while these lesions are quite far away from the overlying skin and nipple to ensure good clearance of cancer tissue.
This surgery is challenging and needs lot of expertise and the specialists of Hyderabad breast clinics are well equipped you to provide the best results with more than 2 decades of experience in cancer care.
Key Features of Nipple-Sparing Mastectomy:
1. Nipple Preservation: Unlike traditional mastectomy or even skin-sparing mastectomy (SSM), the nipple and areola are left intact. The underlying breast tissue, which may contain cancerous cells, is removed, but the outer skin and nipple are preserved.
2. Cosmetic Outcomes: NSM is often favored for its superior cosmetic results. Since the nipple and much of the breast skin are left in place, the reconstructed breast often appears more natural.
3. Immediate Reconstruction: Nipple-sparing mastectomy is frequently followed by immediate breast reconstruction using either breast implants or autologous tissue (flap reconstruction), minimizing the number of surgeries and achieving better aesthetic results.
4. Eligibility Criteria:
- Tumor Location: The tumor should not be close to or involve the nipple-areola complex. If the cancer is near the nipple, the risk of recurrence may increase, and NSM might not be suitable.
- Tumor Size: NSM is typically more appropriate for smaller tumors or for preventive (prophylactic) mastectomy, such as in women with BRCA gene mutations or a strong family history of breast cancer.
- Skin Involvement: If the tumor has invaded the skin or is large, a nipple-sparing approach may not be recommended.
- Patient Anatomy: Women with smaller breasts or less drooping may be better candidates for NSM.
5. Oncological Safety: Studies have shown that in properly selected patients, NSM is as effective in terms of cancer control as more traditional forms of mastectomy. Surgeons may perform a biopsy of tissue behind the nipple to ensure no cancerous cells are present, which would require removing the nipple later.
6. Risks:
- Nipple Necrosis: One potential complication of NSM is that the blood supply to the nipple-areola complex may be compromised, leading to tissue death (necrosis), which could result in partial or full loss of the nipple.
- Recurrence Risk: While rare, there is a slight risk that cancer could recur in the nipple if microscopic cancer cells are left behind.
7. Scarring and Recovery: Scarring is usually minimal, with incisions often placed in inconspicuous areas (such as under the breast). Recovery times can vary, but many patients appreciate the balance between cancer treatment and cosmetic outcomes.
8. Prophylactic NSM: This procedure is particularly popular among women undergoing prophylactic mastectomy due to a high genetic risk of breast cancer (e.g., BRCA mutation carriers). It reduces the risk of developing breast cancer while preserving a natural look.
When is NSM Not Recommended?
- When the tumor is large or involves the skin or nipple.
- When there’s inflammatory breast cancer (an aggressive type of breast cancer where the skin is red and microscopic invasion of cancer would have occurred).
- In some cases where the blood supply to the nipple might be compromised, leading to healing complications.
