Let’s get some terms down here:
Mastectomy: Cutting out the breast. The skin remains, but the breast tissue is gone. Mastectomies traditionally have involved cutting out the nipple areola complex as well.
Nipple sparing mastectomy: You cut out all the breast tissue but you LEAVE the nipple and areola complex. Cosmetically this looks like your normal breast- you just hollowed the stuffing out of the pillowcase. When doing this you are at higher risk of losing the skin (which here the skin= the nipple and areola). When doing a nipple sparing mastectomy minimal use of cautery is wise. You core out the breast ducts which run into the nipple. This specimen is sent for biopsy. Any suspicious intraop pathology would result in resection of the nipple areola complex. Some centers have the ability to assess the vascular perfusion of the flaps during surgery using an injected marker to see blood flow to the area.
Who is even a candidate?
If your breast cancer is too large or close to the nipple areola, it isn’t safe to try this. Other issues are if you are obese, a smoker, or have had prior breast surgery. General indications to consider nipple sparing are:
- smaller tumor
- lesions more than 2 cm from the npple areola complex
- negative axilla on clinical exam (your lymph nodes are not enlarged)
- normal, everted nipples
- no nipple discharge.
- prophylactic mastectomy
More information to come.