Friday, November 26, 2010

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.