Nipple-Sparing Mastectomy

Nipple-sparing mastectomy, also known as total skin-sparing mastectomy, is a type of mastectomy where the skin envelope overlying the breast, including the nipple, is saved. This type of mastectomy can be used for both treating cancer and for prophylactic (preventative) surgery. Nipple-sparing mastectomy is becoming increasing popular because it is followed by immediate breast reconstruction and results in an improved cosmetic outcome. Unfortunately, while the nipple skin is still present, the function and sensation of the nipple is lost.  Long-term outcomes of nipple-sparing mastectomy are yet to be determined. Nevertheless, we do know that in the short term, saving the skin of the nipple does not increase the rate of cancer recurrence (of the cancer coming back). The cancer coming back at the nipple is rare. 

Are complications more likely?

Compared to other types of mastectomy, nipple-sparing mastectomy has a higher complication rate. The most common complication is nipple necrosis (the nipple does not survive because there is not enough blood supply to the nipple). This complication may lead to loss of implant or the need for extra operations.

Who is a candidate for nipple-sparing mastectomy?

There are strict selection criteria for patients who may undergo nipple-sparing mastectomy. These criteria may vary depending on the center where you are treated.

The following patients are not candidates for the procedure:

  • Patients with cancer that either involves the nipple or is very close to the nipple
  • Patients with Paget's disease of the nipple
  • Patients with an abnormality in the tissue underneath the nipple
  • Patients with inflammatory breast cancer

The following patients may not be offered the procedure:

  • Smokers
  • Patients with severe ptosis  (drooping) of the breast 
  • Obese patients or patients with large breasts
  • Patients who have undergone previous radiation therapy

Is it safe for patients with BRCA1, BRCA2 or other genetic mutations?

Although long-term outcomes of nipple-sparing mastectomy in BRCA 1 or BRCA 2 carriers are still needed, current data support the short-term safety of this procedure in this patient population.