Making a Case for Nipple Sparing Mastectomy

In medicine we often become so ingrained in our traditional methods that we fail to venture out of our comfort zone.  So, this month, I would like to introduce a relatively new concept in the management of breast cancer: the Nipple Sparing Mastectomy

For years, the Radical Mastectomy was the standard of care for the treatment of breast cancer.  However, over time, this method of treatment evolved into what we now call a Modified Radical Mastectomy, or MRM, which allows for the preservation of the pectoral muscles.  Ultimately, Dr. Umberto Veronesi’s studies with the National Surgical Adjuvant Breast and Bowel Project (NSABP) demonstrated that the survival rates forbreast cancer were the same when the patient was treated with lumpectomy and radiation treatments instead of a full mastectomy.  Although, at the time, this approach to breast cancer treatment was a radical change, bordering on fringe medicine, now it is an acceptable, if not preferred, option for the management of the disease.

Since then, there have been significant improvements in the area of breast reconstruction, but it has always been “understood” that when a mastectomy is performed the nipple-areola should be removed in order to prevent the recurrence of the cancer.  But this need not be the case.  Why should we save the nipple-areola when performing a mastectomy?  The answer is twofold.  First, the natural nipple-areola is aesthetically far superior to even our best efforts at a fabricated reconstruction.  While our technique in this area has significantly improved, it still has short comings and tends to detract from the final reconstructive result.  Secondly, there is a significant psychological lift when a patient awakes from a mastectomy and her breast is little changed or even improved.  Nipple sparing techniques have the potential to significantly decrease the psychological distress associated with mastectomy and breast cancer treatment.

So what about recurrence of cancer in the nipple-areola after mastectomy?  Recently, there have been several well-designed studies, with adequate follow-up, that demonstrate situations during mastectomy procedures when the nipple-areola can and should be preserved.  These studies have found that there was no recurrence of cancer in the nipple-areola as long as certain very specific criteria were met.

In the age of instant information, patients have a wide variety of options.  They clearly understand that there are situations when the nipple can be saved.  As health care providers, we should be informed and educate our patients so they are comfortable with their options when dealing with breast cancer.  Not every patient may be a candidate for nipple sparing mastectomy, but given the potential benefits, the question should not be “why are we saving the nipple” but rather “why aren’t we.”

If you have any questions about breast reconstruction or any of the other procedures that I perform, please feel free to contact me, Dr. Philip Beegle.  Some reconstructive plastic surgery procedures can be covered by insurance and we provide a variety of options for financing, including CareCreditSM, in order to assist you.  You can also stay connected by following my team on Facebook and we look forward to sharing more exciting news and updates over the upcoming months.