What Is a Nipple-Sparing Mastectomy?

A nipple-sparing mastectomy is a mastectomy procedure where the surgeon leaves the nipple intact, rather than removing it to reduce the risk of cancer recurrence. This can be an option in some patients receiving mastectomies for cancer treatment or prevention. A surgeon can evaluate the patient to determine if it would be an oncologically sound medical decision. If leaving the nipple in place would increase risks for the patient, it will need to be removed, and the patient will need a nipple reconstruction later if she is concerned about the cosmetic appearance of her chest without the nipple.

For a nipple-sparing mastectomy to be successful, the patient needs to receive breast construction at the same time. In an immediate breast reconstruction, after the breast surgeon has removed cancerous or precancerous tissue, a reconstructive plastic surgeon moves in. This surgeon works with the skin flap and tissue left behind to rebuild the breast, using donor tissue from the patient's body or an implant. If necessary, the nipple can be repositioned at this time.

One risk of a nipple-sparing mastectomy is that cancer could recur in or around the nipple. For this reason, the procedure is not recommended for patients with large, invasive, and aggressive tumors, especially if they are close to the nipple. The risk of leaving cancer cells behind is simply too great. Patients with large breasts may also need a nipple relocation, which increases the risk that the tissue will die due to poor blood supply; thus, the procedure may not be recommended for them.

Another concern with nipple-sparing mastectomy is that the nipple may die after surgery because of the disruption to its blood supply. If this occurs, the patient may need another surgery to remove necrotic tissue and rebuild that area of the breast. Patients also have the standard mastectomy risks like infection to consider, along with concerns about breast reconstruction like leaking implants or capsular contracture.

This procedure can save the nipple tissue, but the patient may not experience full sensation after a nipple-sparing mastectomy. Breastfeeding is also not possible, because the tissue within the breast is too damaged. Some patients are pleased with the cosmetic outcome of nipple-sparing mastectomies, as the real nipple tends to look better than a rebuilt version created in reconstructive surgery. Patients with an interest in this procedure can discuss the option with their surgeons and determine if they would be appropriate candidates.