Nipple Sparing Mastectomy

Dennis R. Holmes, M.D. -  - Breast Cancer Surgeon

Dennis R. Holmes, M.D.

Breast Cancer Surgeon located in Santa Monica, CA

Nipple Sparing Mastectomy Specialist
Internationally renowned breast surgeon, Dennis R. Holmes, M.D., F.A.C.S., with locations in Beverly Hills, Santa Monica, Glendale, and Los Angeles, California, has unparalleled expertise in performing minimally-invasive breast surgery, including nipple sparing mastectomies.

Nipple Sparing Mastectomy Q & A

by Dennis R. Holmes, M.D.

What is a nipple-sparing mastectomy?

A nipple-sparing mastectomy (NSM) is a mastectomy in which the contents of the breast tissue are removed while preserving the external skin, nipple and areola.  A variety of  incisions may be used for a nipple-sparing mastectomy.   Hidden-scar nipple sparing mastectomy is performed through an incision in the skin fold under the breast, where the skin is hidden from view from the front of the breast.  Lymph node surgery, if needed, can often be performed through the same incision.  NSM can be performed for cancer surgery and for cancer prevention (prophylactic), and is always combined with immediate breast reconstruction using an implant, tissue expander, or natural tissues.

What is the advantage of a nipple-sparing mastectomy?

The major advantage of a NSM is that Dr. Holmes is able to create a breast that looks as good as or better than the original breast.  In addition, the procedure can often be performed from scars strategically placed under the breast, making them less visible. NSM is a safe procedure with a very low risk.  The risk of cancer recurrence in the nipple is very low (about 0-2%), compared to a similar risk (2-5%) of recurrence when the nipple is not preserved. 

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Are you a candidate for nipple-sparing mastectomy?

NSM can usually be performed if the cancer is not too close to the nipple and areola, and if the breast is not too large or too long. The procedure works best in breasts that are an A, B, and C-cup size.

What are the side effects of nipple-sparing mastectomy?

With any surgeon, one should expect some pain and bruising.   Pain is well managed with pain medications. Bruising will go away after a few days.  Permanent numbness of the breast and nipple areolar area should also be expected, because the nerves of the breast and nipple areolar complex are removed at the time of NSM.   Necrosis or death of the nipple or areas of the breast skin may occur in 5-10% of women undergoing NSM. However, Dr. Holmes has an excellent track record with NSM.  Smoking, nicotine use, obesity, diabetes, and large breast size increase the risk of complications after NSM.

What are the alternatives of NSM?  

There are several alternatives to NSM: skin-sparing mastectomy, areolar sparing mastectomy, and total mastectomy:

  • Skin-sparing mastectomy. Skin-sparing mastectomy is performed when the nipple and areola cannot be safely preserved.  Since most of the nerves to the skin are also removed during SSM, the preserved skin usually remain numb permanently.  Skin-sparing mastectomy is always combined with immediate breast reconstruction.  The nipple and areola may also be reconstructed.

 

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  • Areola-sparing mastectomy.  Areolar-sparing mastectomy is performed when the nipple cannot be safely preserved.  Since most of the nerves to the skin are also removed during areolar-sparing mastectomy, the preserved skin and areola usually remain numb permanently.  Areolar-sparing mastectomy is always combined with immediate breast reconstruction.   The nipple may also be reconstructed. 
  • Total or simple mastectomy.  Total or simple mastectomy is performed when most of the skin of the breast must be removed, or when breast immediate reconstruction is not desired.  However, delayed breast reconstruction may be performed at a later date.  Since most of the nerves to the skin are also removed, the remain skin remains permanently numb.   

 

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