For some women facing a breast cancer diagnosis or a genetic mutation that predisposes them to breast cancer, the word “mastectomy” is terrifying. Thoughts of a mastectomy often produce fear and anxiety because women believe that the operation must mean the loss of the breast shape, skin, sensation, nipple and areola.

Fortunately, we have made great progress since the days of the obligatory radical mastectomy for all breast cancers, and now we can often offer a nipple sparing mastectomy which significantly improves cosmetic satisfaction after mastectomy.

A nipple sparing mastectomy is the process of removing the glandular tissue of the breast while preserving the skin, nipple and areola. Once the breast glandular tissue is removed a plastic surgeon reconstructs the breast mound using a tissue expander and implant or a tissue flap from another part of the body. This can very often be accomplished during the same operation in which the breast tissue is removed. Because the nipple and areola are the central features of the breast, their preservation greatly improves cosmetic satisfaction.

Not every woman with breast cancer is a candidate for this procedure. Tumors that are inflammatory, extremely large, close to or involving the nipple are not ideally treated with this operation. To insure safety, the tissue directly behind the nipple and areola is sampled and analyzed by the pathologist during the operation. This tissue must be free from tumor cells to proceed with nipple preservation. However, with good preoperative planning and imaging it is rare to find unexpected tumor in the large ducts behind the nipple.

Recent studies of nipple sparing mastectomies have shown very low recurrence rates (less than 1 percent) in the preserved nipple and areola. As studies of breast cancer treatment evolve, doctors are able to preserve more aspects of the breast and the breast loss suffered with the removal of breast cancer is increasingly lessened.