Nipple-sparing mastectomy

Surgical procedure preserving the nipple-areola complex during mastectomy

Nipple-sparing mastectomy (NSM) is a type of mastectomy where the nipple-areola complex (NAC) is preserved while removing the underlying breast tissue. This procedure is often chosen for its aesthetic benefits and is typically followed by immediate breast reconstruction.

Indications

Nipple-sparing mastectomy is primarily indicated for patients with breast cancer or those at high risk of developing breast cancer, such as individuals with BRCA1 or BRCA2 mutations. It is suitable for patients with small tumors located away from the nipple and those without invasive cancer involving the skin or nipple.

Procedure

The procedure involves making an incision in the breast, often in the inframammary fold or around the areola, to access and remove the breast tissue while preserving the skin envelope and the NAC. The surgeon carefully dissects the tissue beneath the nipple to ensure no cancerous cells remain.

Incision of breast

Benefits

The primary benefit of NSM is the preservation of the nipple, which can lead to improved cosmetic outcomes and patient satisfaction. By maintaining the natural appearance of the breast, patients often experience better psychological and emotional recovery.

Risks and Complications

While NSM offers aesthetic advantages, it carries risks such as nipple necrosis, where the blood supply to the nipple is compromised, leading to tissue death. Other risks include infection, bleeding, and the potential for residual cancerous tissue.

Reconstruction

Following NSM, immediate breast reconstruction is typically performed using either autologous tissue or breast implants. The choice of reconstruction method depends on patient preference, body type, and medical history.

Breast reconstruction

Outcomes

Studies have shown that NSM can be oncologically safe for selected patients, with recurrence rates comparable to other types of mastectomy. Long-term outcomes depend on factors such as tumor size, location, and the presence of lymph node involvement.

Related pages

• Mastectomy
• Breast reconstruction
• Breast cancer
• BRCA mutation