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Nipple Sparing Mastectomy

Tuesday, May 19, 2015

A new study shows that results of nipple-sparing mastectomy are similar to those of traditional full-breast mastectomy for women with early stage breast cancer. Our breast surgeon explains the procedure and what it means for women with breast cancer.

Dr. Lucy De La Cruz, a researcher at the University of Miami, recently presented a study with data collected from 19 previously published studies that show women with early stage breast cancer who had a mastectomy that preserved the nipple had similar survival or recurrence rates to women who had their entire breast removed.

Doylestown Hospital breast surgeon Donna Angotti, MD, is an expert in the treatment of breast cancer, combining innovation with compassionate care. She answers questions about nipple-sparing mastectomy.

What is nipple-sparing mastectomy, and how does it differ from traditional mastectomy?

A nipple-sparing mastectomy is an operation used to treat breast cancer. The surgeon removes the breast tissue, but preserves all of the overlying skin, including the nipple and darker area around the nipple called the areola.

In traditional mastectomy, the surgeon removes the nipple and areola because of potential risk the cancer might come back in the skin of the nipple.

The incision for a nipple-sparing mastectomy is usually made on the undersurface of the breast as opposed to the middle of the breast in a traditional mastectomy.

Who is a good candidate for nipple-sparing mastectomy?

Good candidates for a nipple-sparing mastectomy are: patients who have smaller tumors that are at least two centimeters (about an inch) away from the nipple area; patients who do not have evidence of tumor cells in the lymph nodes that drain their breast; patients who do not have a type of breast cancer called triple negative cancer, and patients who do not have droopy or sagging breasts.

What are the risks of a recurrence of cancer with nipple-sparing mastectomy?

The American Society of Breast Surgeons just released information at their annual meeting discussing a large meta-analysis reviewing the results of 19 studies of nipple-sparing mastectomies.

These studies compared three types of mastectomy, including:

  1. Nipple-sparing mastectomy
  2. Skin-sparing mastectomy (surgery preserves all of the skin of the breast, except the nipple-areola area)
  3. Modified radical mastectomy (an operation in which the nipple-areola area and more skin are removed)

After five years of study, patients who had the nipple-sparing mastectomy had overall better results and lived cancer-free more often than the other two options. This needs to be followed over a longer period of time as breast cancer recurrences can occur much later than five years after treatment. Certainly, it does not appear to be associated with any harm.

What is done to minimize the risk of cancer coming back in the nipple?

At the time of surgery and while the patient is in the operating room, the tissue directly underneath the nipple is sent for a frozen section or instant analysis that looks for cancer cells. If tests detect tumor cells, the surgeon performs a skin-sparing mastectomy instead. If the frozen section analysis does not show cancer cells, but further testing shows tumor cells in the tissue that was directly underneath the nipple, the patient returns for nipple removal.

Who performs the nipple-sparing mastectomy?

A breast surgeon trained in the nipple-sparing technique performs the procedure, which requires great skill due to the small incision and working space. In conjunction with Doylestown Health's plastic surgeons, I am performing nipple-sparing mastectomies for appropriate candidates. Patient outcomes and satisfaction have been outstanding.

How much sensation does the nipple have following this procedure?

Patients are advised that this operation results in the loss of sensation to the nipple and areola.

What are the benefits to the patient, in addition to cosmetic?

There are psychological benefits for patients who feel the procedure preserves more of their femininity and attractiveness.

What is your experience with performing nipple-sparing mastectomy, and in general, what is the overall experience of the patients you’ve treated?

Once we saw evidence that nipple-sparing mastectomy was safe, we began performing the procedure at Doylestown Health and have been doing so for the past two years. Patients have been exceptionally pleased with their final results, but need to be informed there are multiple procedures involving reconstruction, as well as healing risks. We select only appropriate patients to reduce the risk of any complications.

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