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.
A nipple-sparing mastectomy (NSM) is a mastectomy in which the inside of the breast is removed while preserving the external skin, nipple and areola. A variety of incisions may be used for a nipple-sparing mastectomy. Dr. Holmes most often performs Hidden-scar nipple sparing mastectomy, which is performed through an incision in the skin fold under the breast. This produces a scar that is hidden from view from the front of the breast. Lymph node surgery, if needed, can often be performed through the same incision. In some cases, the location and closeness of cancer to the skin requires placement of the mastectomy incision in other locations. 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 tissue flaps.
The major advantage of NSM is that the outward appears of the breast is preserved or improved. 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 low risk of complications (<10%) and a very low risk of nipple recurrence (<1%) when performed by an experienced surgeon.
NSM can usually be performed if the cancer is not too close to the nipple and areola, and if the breast. 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 opposite, unaffected breast to maintain breast symmetry, to eliminate the need for annual mammograms, or to minimize 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 surgery, 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. Partial or complete necrosis (death) of the nipple or other areas of the breast skin may occur in 5-10% of women undergoing NSM, but in most of these cases the skin heals normally after some care. However, Dr. Holmes has an excellent track record of success 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:
"He treated my daughter who had stage one breast cancer. He put us at ease and calmed our fears , he was the perfect surgeon for our situation."
"He has to be one of the most incredible doctor that I've been blessed to have on my survival team. He's saved my life! I'm a proud 28 yr B C survivor."
"Dr. Holmes is kind, professional, and has a lot of patience answering every question you might have."
"Great and SMART staff. Great place with ZERO infection rate. I was back to work after surgery way sooner then expected! Awesome place great center."
“Thank you so much for being caring and patient with me during this hard transition. I really appreciate your professionalism and dedication.”
“God Bless you, your mind, and your hands, so you may continue to help all women with breast cancer! We thank you for everything that you have done!"
"This week I celebrated my 55th birthday. I cannot be thankful enough for your help in giving me another chance to enjoy waking up each day."