Nipple Sparing Mastectomy
Nipple sparing mastectomy can be safe when cautiously applied in patients with tumor located away from the nipple and nipple involvement is unlikely. Other considerations for determining nipple preservation would be nipple location. For example, a breast with high degree of ptosis, where the nipple is located at the inferior aspect of the breast would not be an ideal candidate for preservation of the nipple. Decisions on whether or not to have nipple sparing mastectomy can not be made solely on the patients desire to preserve her nipple but are determined on the overall safety and efficacy of nipple preservation.
The nipple and areola are traditionally removed during mastectomy due to the concern of possible involvement of cancer within the nipple, which could result in reccurrence of cancer following mastectomy.
In efforts to preserve as much of the native breast as possible and provide better reconstructive outcomes additional research performed over the past decade that has found there is a select group of patients with breast cancer that can undergo this procedure with reasonable safety when certain selection criteria are met.
This allows for selected patients to undergo mastectomy and keep their native nipple and areola, thereby requiring less overall reconstructive procedures.
Benefits of nipple preservation include maximal preservation of the native breast and likely best outcome regarding reconstruction. Risk would include recurrence of cancer at the nipple but this is generally considered a low risk due to selection criteria. It is important to remember that there is always a risk of cancer recurrence with any type of mastectomy. Additionally, with nipple preservation the is approximately a chance of partial or total nipple loss.