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Nipple-Sparing Mastectomy Aids Reconstruction
For women who must undergo mastectomy, a procedure sparing the nipple may make breast reconstruction look more natural. This is important since a woman’s body image can suffer after the ordeal of breast removal. And even better, the surgery does not appear to risk relapse any more than conventional mastectomy.
Researchers followed 162 women who had a special type of mastectomy called nipple-sparing mastectomy (NSM), which removes the breast tissue, but leaves the nipple and surrounding areola in tact. The women underwent the surgery either to treat breast cancer or to prevent it – some women without cancer opt for mastectomy because they have a family history or a specific genetic profile that puts them at very high risk.
In the women who underwent NSM, none had recurrence of the cancer and no new cancers grew.
The concern with NSM is that by leaving the nipple, it is possible to miss cancer cells, which could hide under the nipple. In this case, the risk of relapse of breast cancer could be relatively higher. But the researchers did not find this to be the case at all. However, author Scott Spear, who is professor of plastic surgery at the Georgetown University Hospital, where the study took place, cautions that the “nipple-sparing technique is not appropriate for every patient depending upon their anatomy and type of breast pathology. Careful selection of the right patient for NSM is an important element of success."
One consideration in the study was that breast tissue under the nipple was biopsied after the surgery: If cancerous cells were found, the nipple and abnormal cells were removed, which helped reduce the likelihood for relapse. Some of the women’s nipples also became necrotic (suffered tissue death) and had to be removed, which is a risk for the procedure.
Georgetown breast surgeon Shawna C. Willey underlines the importance of helping women feel good about their bodies after surgery, which can be difficult to deal with. “We need to be able to offer women options that they know will successfully treat or prevent their cancer,” said Willey, “while at the same time, preserve their quality of life whether it be in their appearance or psychologically. Nipple sparing mastectomy goes a long way toward reaching that goal.”
Given the apparent safety of the surgery, we may see it becoming more common in the years to come, as doctors and patients become increasingly aware that it presents a viable option. According to Spear, "[a]s more data become available, I think we'll see nipple sparing mastectomy play a larger role, particularly in the prevention setting." If you are in the position of requiring a mastectomy, it is important to discuss all the options with your doctor, so that the best decision can be reached.
The research was carried out at Georgetown University Hospital, and will be published in the November 2011 issue of Plastic and Reconstructive Surgery.
November 5, 2011