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.
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.
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.
Women with breast cancer may choose contralateral prophylactic mastectomy (CPM) or preventive removal of the unaffected breast to maintain breast symmetry, to eliminate the need for annual mammograms, or due to anxiety about the future risk of cancer in the opposite breast. You can calculate your personal risk of contralateral breast cancer (CBC) by visiting the following link: https://cbc-predictor-utd.shinyapps.io/CBCRisk. CPM is usually covered by insurance. A 20-year risk of CBC of 5% or less is considered LOW.
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.
There are several alternatives to NSM: skin-sparing mastectomy, areolar sparing mastectomy, and total mastectomy: