Nipple Sparing Mastectomy (NSM)

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Women facing surgery for breast cancer may be candidates for newer techniques that improve the appearance of their breast reconstruction. Skin sparing mastectomies have been used now for several years to treat early stage breast cancer meeting certain criteria. However, nipple sparing mastectomies have met with greater concern and are not as widely performed.

The advantage of a nipple sparing mastectomy is that the nipple may retain sensation and erectile ability while nipples created with grafts, tattoos or reconstructed do not. The risk of having a nipple sparing mastectomy is uncertainty as to whether cancer may return because the nipple was saved. For women who are interested in this type of mastectomy, there are naturals concerns as to whether it is a good or bad idea to try to preserve their nipple.

A nipple-sparing mastectomy is difficult to perform because the surgeon needs to remove much of the tissue inside the breast to make sure there is no cancer left while still leaving the breast skin and nipple intact for reconstruction. Most of the nerves and blood vessels that provide sensation and erectile ability of the nipple will be removed so there is no assurance that the woman will actually regain sensation or that enough blood supply will be left to support the nipple tissue. The nipple may later need to be removed. Nipple sparing mastectomies have only been performed for the last few years so there is no tried and true best technique.

Those selected to have nipple-sparing mastectomies must first meet the criteria of skin sparing mastectomies. (See my article: Skin Sparing Mastectomy (SSM) at www.empowher.com/news/herarticle/2010/02/08/skin-sparing-mastectomy-ssm.) The tumor must be at least 2 cm (about 1inch) from the nipple, smaller than 3 cm (1and a half inches) and meet other oncology restrictions. Additionally, during the surgery a specimen from the nipple will be sent for microscopic evaluation.

If the nipple and skin area are deemed cancer free, the woman will have her breast with nipple intact reconstructed immediately after the cancer tissue is removed. Afterwards, the woman will be followed by her doctor with frequent visits for the first year, then yearly with a final check up at five years. If needed a biopsy or other imaging procedures to check for problems will be done. If all goes well, the nipple will survive and the breast and surrounding areas will remain cancer free.

Without more clinical trials it is hard to determine if nipple sparing mastectomies are really an option women should be concerning themselves with amid all the other decisions that need to be made. Women who are having breast removal for prophylactic reasons, for example, Brca positive genes are probably the best candidates though other low risk tumors are considered.

Cancer reoccurrence after a mastectomy has been found to be around 5 percent. Cancer reoccurrence after nipple sparing mastectomies whose primary tumor was more than 2 cm away from the nipple was 6 percent according to OncoLog. Though this risk appears to be low, not all women are willing to take a chance, even if it means losing a chance to keep a part of themselves that for many defines their sexuality and sense of self.

Decisions about breast surgery with or without the nipple or skin saving must be thoroughly discussed with a woman’s oncologist and plastic surgeon so that a woman is truly informed about the breast reconstruction decisions she might like to have versus those she is willing to live with.

sources:

www2.mdanderson.org/depts/oncolog/articles/08/12-dec/12-08-2.html
http://health.yahoo.com/experts/breastcancer/6744/nipple-sparing-mastectomy/
www.newsguide.us/lifestyle/dating-singles/Nipple-Sparing-Mastectomy-and-Breast-Reconstruction-Can-Preserve-the-Natural-Look-of-the-Breast-Says-Houston-Plastic-Surgeon-Norman-Rappaport-MD-FACS/

Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues. Other articles by Michele can be read at http://www.helium.com/users/487540/show_articles

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.