Written by Christine G. Adamo
Reviewed by: Dr. Richard Baxter
Revolutionary mastectomy techniques have emerged in recent years. They offer women with early stage breast cancer (and, at times, more advanced stages) options in breast reconstruction which are easier to perform, more aesthetically sound and devoid of the unpleasant side effects caused by lumpectomy related radiation and/or hormone treatment.
Skin and nipple sparing mastectomy and immediate breast reconstruction using breast implants is one such option. This all-in-one procedure helps you avoid lumpectomy, radiation and anti-estrogen drug treatment yet yields comparable results. What’s provided here is a brief guide to understanding this breast cancer surgery option.
What Skin and Nipple Sparing Mastectomy Is
Skin and nipple sparing mastectomy is an alternative treatment for early-stage breast cancer which aids breast reconstruction while preserving as much of the skin and nipple areola complex as possible. In nearly all cases, it is followed by immediate breast implant based breast reconstruction.
This plastic surgery technique offers many benefits, which include:
- Comprehensive, all-in-one surgical treatment
- Higher levels of breast tissue, skin and areola conservation
- No need for radiation, anti-estrogen or other hormone treatment
- Shorter overall procedure and recovery times to get you moving again
- Breast cancer surgery that leaves you feeling great, with few side effects
- Aesthetically-pleasing results without the risk of breast deformity or asymmetry
During a skin and nipple sparing mastectomy (followed by immediate breast implant based breast reconstruction), breast tissue is removed from both breasts while leaving your surrounding skin and nipple areola complex intact. Lost tissue is then immediately replaced with breast implants which are appropriate to your body type.
Skin sparing and nipple sparing mastectomy also aids breast reconstruction by allowing a plastic surgeon to address each of your concerns in one procedure. For example, prior to inserting your breast implants acellular matrix grafts are used to create an internal bra which offer lasting support for your new breasts – avoiding the lengthy, and often painful, tissue expansion process.
This differs from breast reconstruction after traditional or modified radical mastectomy – which entails removal of the skin, nipple and possibly muscle tissue – wherein your remaining skin is pulled taught and (once the area heals) is typically insufficient to provide cover and support for breast implants. Tissue expansion is then required to create a pocket along the chest wall, stretching the skin over time. That process alone can last six months.
Work with a board-certified plastic surgeon willing to provide you a detailed understanding of each step in the skin and nipple sparing mastectomy and immediate breast implant based breast reconstruction process. Request to see evidence of their work (ex: before and after photos) and ask for patient testimonials or referrals.
Studies Related to Skin and Nipple Sparing Mastectomy
The Breast Service division of the Department of Surgery at Memorial Sloan-Kettering Cancer Center in New York City recently had its findings on nipple sparing mastectomy published by the Annals of Surgical Oncology.
Via “Nipple Sparing Mastectomy for Breast Cancer and Risk Reducing Surgery: The Memorial Sloan-Kettering Cancer Center Experience”, Sloan-Kettering reported:
“Nipple sparing mastectomy has been gathering increased recognition as an alternative to more traditional mastectomy approaches. Initially, questions concerning its oncologic safety limited the use of NSM. Nevertheless, mounting evidence supporting the practice of NSM for both prophylactic and oncologic purposes is leading to its more widespread use and broadened indications.”
Over a 10 year period, experts at Sloan-Kettering performed 353 nipple and skin sparing mastectomy procedures on 200 patients diagnosed with various stages of breast cancer – 23.3% of them considered invasive. Using post-operative results, the center compiled the study mentioned above.
In 96.7% of all cases, nipple sparing mastectomy helped entirely preserve women’s nipple areolar complex. In cases where it did not, the primary cause was cancer found at the nipple margin which required further excision and was not caused by the procedure itself. Additionally, only 1-in-353 patients suffered a recurrence of cancer.
The conclusion was drawn that while nipple sparing mastectomy is not yet considered standard practice its use can be beneficial “in both prophylactic (or preventative) and malignant settings.”
A few months earlier the Dept. of Gynecology at Technische Universität, in Germany, had its own findings on nipple sparing mastectomy published in The Breast Journal. Entitled “Extended Indications for Nipple Sparing Mastectomy”, it found that while traditional breast cancer surgery still involves “the routine excision of the nipple-areola complex” nipple sparing mastectomy “preserves the entire skin of the breast and the NAC”.
For this reason, it was called a “safe option for patients with small and peripherally located tumors and probably for high-risk patients (undergoing) prophylactic mastectomy”. It was also said to be “feasible even in patients with large centrally located tumors or multi-centric invasive carcinoma (and) the range of indications for NSM needs not to be limited to small peripheral tumors or to prophylactic treatment.”
Experts at the Div. of Breast Surgical Oncology at the Dept. of Surgery at Winthrop P. Rockefeller Cancer Institute (University of Arkansas for Medical Sciences in Little Rock) agreed. Its findings on skin and nipple sparing mastectomy were published in the Journal of the American College of Surgeons.
In “Oncologic Safety of Nipple Skin Sparing or Total Skin Sparing Mastectomies with Immediate Reconstruction”, they shared findings of a study in which 281 total skin sparing mastectomies (TSSMs, in which the skin overlying the nipple-areola complex is left in tact) and 277 skin sparing mastectomies (SSMs, in which it is removed) were performed.
Both procedures were followed by immediate breast reconstruction. Low complication and recurrence rates were found among both groups. Yet, TSSM was said to offer superior cosmetic results.
Because it “affords one-step immediate reconstruction” it was also suggested for patients with stages I and II breast cancer and those down-staged with neoadjuvant chemotherapy – defined by the National Cancer Institute (or NCI) as “treatment given before primary therapy”, or mastectomy, to shrink inoperable tumor size prior to surgery.
Other Considerations – Traditional Lumpectomy & Radiation Treatment
Unlike skin and nipple sparing mastectomy and immediate breast implant based breast reconstruction, traditional lumpectomy and radiation treatment can further complicate your experience with early-stage cancer and the entire breast cancer surgery process.
Lumpectomy can result in breast deformity and breast asymmetry and is often followed by a weeks-long course of radiation therapy to stave off recurrence. Risks associated with radiation include:
- Fatigue
- Diarrhea
- Skin Discoloration
- Difficulty Eating &/or Swallowing
- Radiodermatitis (Radiation Dermatitis)
- Skin burns
Even after undergoing a lumpectomy women with receptor-positive or hormone-sensitive cancers are typically prescribed anti-estrogen drugs to suppress naturally-produced hormones which fuel tumor growth. The NCI cites serious side effects of anti-estrogen treatment, such as: Blood clots, strokes, uterine cancer and cataracts. Other side effects mimic symptoms of menopause and include:
- Hot Flashes
- Vaginal Dryness
- Leg Cramps
- Joint Pain
With skin and nipple sparing mastectomy, no radiation therapy is necessary. There is no anti-estrogen drug treatment. In one procedure, cancerous tissue is removed, implants are inserted and your healing begins.