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Nipple Sparing Mastectomy/ Cancer Prevention Mastectomy

Fairbanks Plastic Surgery Nipple Sparing Mastectomy

About this procedure

The nipple sparing mastectomy–or subcutaneous mastectomy–followed by a submuscular implant for reconstruction, offers the best appearing breast after the removal of breast glandular tissue due to cancer or other disease. It can also be used for the prevention of breast cancer in high risk patients. After the mastectomy has been performed, a breast reconstruction procedure is performed in a second stage, utilizing a sub-muscular breast implant, to offer a more natural looking result compared to other breast reconstructive procedures. The alternative of fat injection grafting is also an effective means of restoration of the breast following the nipple-sparing mastectomy.

Radiation makes breast reconstruction more difficult. While a lumpectomy combined with radiation may be an appropriate solution for a limited breast cancer, it frequently does not leave the patient with an attractive appearance. With a lumpectomy, there is usually a defect in the shape of the breast, but most of the breast glandular tissue remains. With a nipple sparing mastectomy, 90% of the glandular tissue — tissue at risk for cancer — is removed. The remaining 10% is directly beneath the nipple, and can be easily checked should a tumor develop there in the future. The small disc of tissue beneath the nipple allows for blood supply to the nipple, which is necessary at the time of surgery.

Although not commonly thought to be “cosmetic surgery,” the results from this operation can indeed be cosmetic, and the results can be highly acceptable, from a visual standpoint, when performed correctly. For the best results, two stages are required. After removal of the breast glandular tissue, the skin and subcutaneous tissue must adhere to the muscular chest wall. Three to four months later, an implant is placed beneath the chest wall muscle. The muscle provides the necessary soft tissue coverage to camouflage the implant. Good results can be anticipated thereafter. The post-operative appearance is generally superior to other forms of breast reconstruction.

An alternative to breast implants is fat injection grafting to the breast to reestablish breast volume. Unlike the breast implant, fat injection grafting requires more than one stage in order to achieve the desired volume. The advantage of fat injection grafting to the breast lies in the fact that it is all the patient’s own living tissue. The final result is normal looking breasts. The combination of nipple sparing mastectomy for the prevention of breast cancer, followed by fat injection grafting, is far superior in appearance than any other breast reconstruction procedure.

If a large percentage of a patient’s female relatives developed breast cancer, the patient may be at a higher risk for developing breast cancer and a candidate for a nipple sparring mastectomy with later reconstruction using an implant. For patients with the BRCA 1 or 2 gene a nipple sparing mastectomy — or preventive mastectomy — is especially important, since it can help prevent the otherwise extremely high risk of breast cancer, and the patient can still have attractive breasts.

Stage 1: Nipple Sparing Mastectomy

Nipple Sparing Mastectomy before and after
In these pictures we see the cancerous, or otherwise diseased breast in its pre-operative state in the top pictures, and in its post-operative state in the bottom row. The breast glandular tissue has been removed, but the nipple remains.

Stage 2: Reconstruction

Nipple Sparing Mastectomy before and after
In these pictures, you see the post-operative mastectomy in the first row as the result of a nipple sparing mastectomy. The appearance following breast reconstruction can be seen in the second row.

Stage 1: Nipple Sparing Mastectomy

Nipple Sparing Mastectomy before and after
In these pictures, we see the pre-cancerous breast in its pre-operative state in the top pictures, and in its post-operative state in the bottom row following nipple sparing mastectomy

Stage 2: Reconstruction

Nipple Sparing Mastectomy before and after
In these pictures, you see the the result of a nipple sparing mastectomy in the first row, and the results of the breast reconstruction in the second.

Stage 1: Nipple Sparing Mastectomy

Nipple Sparing Mastectomy before and after
In these pictures we see the cancerous right breast in its pre-operative state in the top pictures, and in its post-operative state in the bottom row following a nipple sparing mastectomy.

Stage 2: Reconstruction

Nipple Sparing Mastectomy before and after
In these pictures, you see the post-operative views in the first row as the result of a nipple sparing mastectomy. Breast reconstruction has been performed on the right side in the second row.

Nipple Sparing Mastectomy with Fat Injection Grafting

Nipple-sparing mastectomy followed by fat injection grafting

In the top row of these pictures, you see the post-operative result of a nipple sparing mastectomy. In the second row, the patient has received fat injection grafting reconstruction.

*All before and after photos are real patients of Fairbanks Plastic Surgery.