What Patients Should Know About Nipple-Sparing Mastectomy for Breast Cancer

For some people with breast cancer, mastectomy can be an important part of treatment. But advances in breast surgery are giving patients more options that consider not only removing cancer, but also how their breasts look and feel after treatment.

One of those approaches is nipple-sparing mastectomy, a procedure that removes breast tissue while preserving the nipple and the skin covering the breast.

According to Dr. Kaye Lu, a breast surgical oncologist at El Camino Health, newer techniques are also changing how nipple-sparing mastectomies can be performed, potentially allowing patients to have smaller, less visible incisions and a different recovery experience.

What Is a Nipple-Sparing Mastectomy?

During a traditional nipple-sparing mastectomy, the surgeon removes the breast tissue while preserving the skin and nipple. An incision is typically made along the lower portion of the breast, near the breast fold.

“This means that we preserve the skin and the nipple overlying that area and remove the breast tissue underneath that area,” Lu explained.

The incision can be relatively large, potentially measuring up to several inches. Following the removal of breast tissue, patients may undergo reconstruction using a tissue expander or breast implant.

Preserving the nipple can be an important consideration for patients who are candidates for this approach because it can help maintain the appearance of the breast following mastectomy.

How Is Endoscopic Nipple-Sparing Mastectomy Different?

An endoscopic nipple-sparing mastectomy uses a different approach to accessing and removing the breast tissue.

Rather than making a larger incision underneath the breast, surgeons make a smaller incision on the outer portion of the breast. The incision is positioned so it can be hidden by the patient's arm.

“The incision itself is only about three to four centimeters long,” Lu said.

Because the opening is much smaller, surgeons cannot use the same instruments typically used during a traditional mastectomy. Instead, they use specialized laparoscopic instruments along with a camera to remove the breast tissue through the smaller incision.

Lu described the instruments as specialized extensions of the surgeon's hands that allow the procedure to be performed through the smaller opening.

Why Might Patients Consider an Endoscopic Approach?

One of the potential advantages of an endoscopic nipple-sparing mastectomy is the location and size of the incision.

Because the incision is placed on the outer portion of the breast, it can be concealed by the patient's arm. This means that when patients look at themselves from the front after surgery, the incision may not be visible.

For patients concerned about scarring and changes to their appearance following mastectomy, this can be an important consideration.

But the potential benefits may extend beyond appearance.

Lu said the smaller incision may cause less disruption to blood flow to the surrounding skin and nipple. This could reduce certain wound-healing complications, including skin or nipple necrosis, in which tissue dies because it does not receive enough blood flow.

Patients may also experience less pain because of the smaller incision.

According to Lu, some data also suggest that patients may experience improved skin sensation following the procedure because the smaller incision can help preserve nerves that cross the skin.

What Does Recovery Look Like?

Recovery varies from patient to patient, but Lu said many patients undergoing an endoscopic nipple-sparing mastectomy are able to return home the same day.

Some patients may also qualify for direct-to-implant reconstruction, allowing them to skip the tissue-expander stage of reconstruction.

A tissue expander is a temporary device used to gradually stretch the skin and create space for a future breast implant.

Another potential benefit is that patients may experience less swelling and bruising following surgery.

“From the front, they look like they would normally look with the reconstructive breast,” Lu said.

Reducing wound complications can also be important for patients who need additional cancer treatment after surgery. Lu explained that avoiding complications can help patients progress through their treatment without unnecessary delays when radiation or chemotherapy are part of their treatment plan.

How Nipple-Sparing Surgery Can Affect Quality of Life

The physical appearance of the breast after cancer surgery can have an emotional impact on patients.

A surgical scar can serve as a daily reminder of a cancer diagnosis and may affect a person's confidence, self-image and sense of femininity. These changes can also affect intimate relationships.

Because nipple-sparing mastectomy preserves the nipple and breast skin, it can offer patients who are appropriate candidates an option that takes these concerns into consideration.

The endoscopic approach takes this concept further by placing the surgical incision in a less visible location.

For Lu, these quality-of-life considerations are an important part of the evolution of breast cancer surgery.

“We’re trying to do more minimally invasive surgery,” Lu said, pointing to endoscopic nipple-sparing mastectomy as one example.

What Patients Should Ask Their Breast Surgeon

Nipple-sparing mastectomy is not appropriate for every patient. Whether someone is a candidate depends on factors related to their breast cancer and overall treatment plan.

Patients who are considering mastectomy can ask their breast surgeon about the different surgical and reconstruction options available to them, including:

• Whether they are a candidate for nipple-sparing mastectomy
• The differences between traditional and endoscopic nipple-sparing approaches
• Where the surgical incision would be placed
• How surgery could affect sensation
• Reconstruction options, including direct-to-implant reconstruction
• Potential complications and recovery time
• How surgery could affect the timing of additional cancer treatments

As breast cancer surgery continues to evolve, surgeons are increasingly considering both cancer treatment and patients' quality of life when planning procedures.

For patients who are candidates for nipple-sparing mastectomy, newer approaches such as endoscopic surgery may offer another option for preserving the nipple and breast skin while minimizing the visibility of surgical scars.

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