Mastectomy is a surgical procedure commonly performed to treat or prevent breast cancer by removing breast tissue. A frequent question arises regarding the removal of the nipple during this procedure. The approach to nipple preservation is not uniform and depends on a variety of individual patient and tumor characteristics.
Understanding Mastectomy and Nipple Removal
A mastectomy involves the removal of breast tissue, a necessary step in addressing breast cancer or reducing cancer risk. Traditionally, a total mastectomy includes the removal of the entire breast, along with the nipple and areola, which is the darker skin around the nipple. This comprehensive removal ensures all cancerous or at-risk tissue is eliminated, minimizing cancer recurrence in that area. While traditional methods often involve nipple removal, modern surgical advancements have introduced techniques that allow for nipple preservation in specific cases.
When Nipple Preservation is an Option
Nipple preservation is a possibility in certain mastectomy procedures, specifically known as nipple-sparing mastectomies (NSM). This technique involves removing all breast tissue but preserving the skin of the breast, as well as the nipple and areola. NSM is considered safe for selected patients, with comparable rates of local cancer recurrence to traditional mastectomies.
Medical criteria for NSM include the tumor’s characteristics, such as being small, peripherally located, and not directly under or involving the nipple. Pathologists carefully examine the tissue under and around the nipple during surgery to confirm the absence of cancer cells. Patients with inflammatory breast cancer or Paget’s disease are not candidates for NSM.
Factors Influencing the Decision
The decision to preserve the nipple during a mastectomy involves several considerations beyond just medical feasibility. Patient preferences play a substantial role, as many value maintaining a more natural appearance and body image. The surgeon’s expertise and recommendation are significant, as successful nipple preservation requires specialized surgical skill.
Potential cosmetic outcomes, such as the risk of nipple necrosis (tissue death) or an altered appearance, are openly discussed. Nipple preservation may offer some retained sensation, though this varies among individuals. Ultimately, the choice is a shared decision between the patient and their medical team, weighing all benefits and risks.
Nipple Reconstruction After Mastectomy
For individuals who undergo nipple removal during a mastectomy, various options exist for nipple reconstruction. One common surgical technique involves using local tissue flaps from the reconstructed breast to create a projection that mimics a nipple. Alternatively, skin grafts can be used.
Following surgical nipple reconstruction, tattooing is used to create the areola and add color and definition to the reconstructed nipple, enhancing its realistic appearance. This tattooing occurs three to four months after the initial reconstruction to allow for adequate healing. Some individuals may opt for 3D nipple tattooing without surgical reconstruction, which uses shading and color to create the illusion of a raised nipple. These reconstruction methods offer psychological benefits by helping restore body image and confidence.