Nipple-Sparing Mastectomy: The Ultimate Aesthetic in Breast Reconstruction

Over the last 10 years, there has been an increasing awareness among General/Breast Surgeons that in many cases, it is not necessary to remove the breast skin along the breast tissue. This is called NIPPLE-SPARING MASTECTOMY (NSM):

Advantages of the NSM and immediate reconstruction technique:

1. It is a single-stage technique with only one general anesthetic in the majority of cases
2. There are no visible scars on the breast, unless later mastopexy ("breast lift") is desired or needed
3. It is performed using an adjustable permanent implant, not a tissue expander, OR a flap reconstruction
4. The implant or flap is placed over the muscle to avoid animation ("motion") deformities when the pectoralis major muscle flexes
5. The recovery is shorter and involves significantly less pain than traditional two-stage expander-implant breast reconstruction
6. This is an oncologically safe, unique mastectomy technique which cores out the nipple on the involved side for additional Pathological tissue analysis
7. In some cases, it is possible to perform a nipple lift (mastopexy) at the same time as the mastectomy and reconstruction
8. This technique is the simplest, quickest, most aesthetically pleasing technique for women who are considering prophylactic mastectomy for genetic risk.
9. There is no delay of radiation or chemotherapy due to a speedy recovery and extremely few wound healing problems

The NSM technique has taken years to refine, but we believe it is the simplest and most aesthetic single-stage implant reconstruction. It is also being used in our practice with the DIEP flap and other microsurgical flaps such as the inner thigh (TUG) flap.
 
NSM is ideal for women who are carriers of the BRCA-1 or BRCA-2 gene and other women with a strong family history of breast cancer who are seeking prophylactic mastectomy and breast reconstruction. It is also appropriate for women with DCIS and invasive cancer that is at least 2 cm away from the nipple.

For those women who have tumors which are very large, very aggressive, or involving the nipple, single stage reconstruction removing the nipple is still available. This is also done over the muscle in our practice.
 
NSM is performed through an incision hidden under the breast, in the breast fold ("inframammary fold"), limiting the scar.  Following mastectomy, in the same operation, reconstruction is performed using either an implant or a flap. 

Read about my patient Desdemonia's experience with this procedure!

If an implant is placed, it is located in the exact same space that the breast was, on top of the pectoralis major muscle.  A permanent, adjustable implant is used.  It is inflated approximately 60%-80% of the way at the time of surgery; only one or two additional inflations are required in the office in the 1-2 week period following surgery.  No "expansion" of the breast skin is needed, as the implant is not used to stretch the skin but is used to "fill out the space".  The great thing about these types of implant is that the woman undergoing the procedure is empowered to make the final decision about her desired implant size, not the surgeon!

A flap placed for reconstruction provides the ultimate soft, warm, living tissue reconstruction that has none of the risks and potential complications of implants.  

Please visit our website for more information.

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Breast Cancer In Young Women May Be Hereditary

Many women presenting to my office for breast reconstruction do not actually have breast cancer.

Many of them have a strongly positive family history for breast and/or ovarian cancer, and upon testing, they may learn they carry the BRCA gene. They may wish to have prophylactic (preventative) mastectomy and reconstruction to lower their risk of developing breast cancer.

Read the article below on hereditary breast cancer from the latest FORCE publication:


WHAT is hereditary cancer?

Breast cancer can result from changes in genes called "hereditary mutations." These gene changes can be passed down from the mother or the father to daughters or sons and cause cancer to run in some families.

The genes most often associated with hereditary breast cancer are called BRCA1 and BRCA2.
Changes in these genes can increase the risk for breast, ovarian, and other types of cancer.

If you have had breast cancer at age 50 or younger, you are more likely to have a BRCA mutation if you have:

• had ovarian cancer
• breast cancer in both breasts
• a relative with ovarian cancer at any age
• a relative with breast cancer at any age
• a relative with male breast cancer
• a relative with pancreatic cancer
• a relative with prostate cancer
• Eastern European Jewish (Ashkenazi Jewish) heritage

Women with “triple negative” breast cancer (one that is negative for estrogen receptors, progesterone receptors, and Her-2/neu status) may be more likely to have a BRCA1 mutation.

WHAT is gene testing and how would it affect me?

If you are a young woman who has been diagnosed with breast cancer, you can take a blood test (or a genetic test using cells swabbed from the inside of your cheek) to find out if you carry a BRCA gene mutation.

Cancer genetics experts include genetic counselors, risk assessment counselors, geneticists and other physicians with advanced training in genetics and hereditary disease. Before gene testing, you should talk with a genetics expert to learn if your cancer may have been caused by a BRCA mutation, and to help you and your family members decide if gene testing is right for you.

(I usually refer my patients to their breast surgeon or an oncologist to determine whether genetic testing is appropriate for them).

Learning that your breast cancer is hereditary may change treatment or follow-up recommendations. If you test positive for a mutation, each of your children and siblings has a 50% chance of carrying the mutation. Aunts, uncles, nieces, nephews, and cousins may carry the mutation, too.

If you test positive for a mutation, your risk for a second breast cancer and other cancers may be
increased. If you test negative for these mutations, your risk for additional cancers depends on other factors. A genetics expert can help you better understand your risks for additional cancers.

The cost for gene testing can vary depending on which test is ordered. The cost is usually covered for young women diagnosed with breast cancer, either in part or in full, by insurance carriers.

WHERE can I learn more about hereditary cancer?

Experts in cancer genetics can help you understand hereditary cancer and provide you and your family with information about your cancer risk. They will:

• review your family medical history to assess and explain your risk for cancer
• describe the benefits and drawbacks of gene testing and discuss whether you are a candidate for testing
• order the appropriate test if you choose to proceed with gene testing
• assist with insurance coverage of testing
• interpret gene test results and explain what they mean for you and your family
• discuss how to manage your cancer risk and refer you to experts for follow-up care

If you are a young woman with breast cancer, please talk with a genetics expert and your doctor about gene testing for a hereditary mutation!

To find an expert in your area, or to receive support and information visit www.facingourrisk.org or call the helpline at (866) 288-RISK (7475)

Women who develop breast cancer before age 50 are more likely to have one of these gene changes than women who develop breast cancer after age 50. There are options available for you and your family members to lower cancer risk and to detect cancer at an earlier, more curable stage.

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