Nipple-Sparing Mastectomy

In a nipple-sparing mastectomy, your surgeon will remove all the tissue that fills your breast while keeping the skin, nipple and areola intact. Typically, a cancer surgeon works closely with a plastic surgeon on this procedure.

Your surgeon will:

1. Discuss in advance where they’ll place the cut (incision): During the surgery, they’ll make the incision where you discussed.
2. Remove all your breast tissue from under your skin: They’ll leave a thin layer of subcutaneous fat to provide blood supply to your skin.
3. Reconstruct your breast, if planned: Depending on your plan, your plastic surgeon might fill your breast “envelope” with either an implant or tissue taken from somewhere else on your body. Or you might choose to go “flat.”

An endoscopic nipple-sparing mastectomy (E-NSM) is a minimally invasive version of a nipple-sparing mastectomy. Instead of making a large incision on your breast, your surgeon will make a small incision in a less visible area. This is usually near the side of your chest, or under your breast or armpit.

After they make the incision, your surgeon will insert a long, thin device called an endoscope through the opening. The endoscope has a camera and surgical tools. Your surgeon will use these tools to remove your breast tissue while preserving your nipple, areola and skin.

The goal of E-NSM is to achieve the same outcome as a conventional NSM with a better cosmetic result. It leaves less visible scarring, and you might have a faster, more comfortable recovery.

The timing of a nipple-sparing mastectomy can vary from person to person. It depends on the size and shape of your breast, as well as the surgical technique your surgeon uses. An endoscopic NSM can take about 30 minutes longer than a conventional NSM.

When it’s successful, a nipple-sparing mastectomy can be associated with a higher overall satisfaction rate compared to other types of mastectomies. But there’s a risk it won’t succeed if the nipple loses its blood supply during healing. The risk of breast cancer recurrence after NSM is the same as with other types of mastectomies.

Benefits

The primary benefits include:

• More natural appearance: NSM produces a cosmetic result that looks more like your original breast. This often includes less noticeable scars. Women report feeling better about this result overall. It feels less like “losing” the breast and leads to better self-esteem after mastectomy.
• Potential for keeping some sensation: In some people who have nipple-sparing mastectomies, some sensation eventually returns to the nipple. Based on current studies, the chance of this happening is probably less than 50%.

Risks

The primary risk is losing your nipple. The NSM operation can temporarily disrupt the blood flow to your skin and nipples. Blood flow should return with healing. But if your breast doesn’t heal well, and blood flow isn’t restored, the tissues can start to die.