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The Voice of Canadians With Breast Cancer

Education

Our Voices Blog

Considerations for Nipple Sparing Mastectomy

What is Nipple Sparing Mastectomy?

Nipple Sparing Mastectomy (NSM) is a surgery performed on individuals removing their breast due to breast cancer or as a risk reduction method to prevent breast cancer. During this procedure, a small cut is made in the breast and the entire breast glandular tissue is removed from underneath the skin and nipple, leaving them intact. Breast reconstruction, using either an implant or natural tissue, is then performed at the same time. NSM is a procedure that attempts to balance the preservation of the breast area with an effective and successful breast cancer treatment.

When is Nipple Sparing Mastectomy Used?

In most cases, women who get a lumpectomy as their breast cancer treatment require radiation treatment afterwards. However, when it comes to mastectomies, research from the US shows that around 70% of the 300,000 new breast cancer cases diagnosed annually with early stage breast cancer may not require radiation after complete mastectomy. NSM therefore presents as an opportunity for women for avoid the many side effects that come with radiation.

Who Should Consider Nipple Sparing Mastectomy?

NSM may be best for 1:

  • women whose tumor does not involve the nipple or tissue under the areola
  • women whose tumors are surrounded by a clear margin of cancer-free tissue
  • women who have not been diagnosed with inflammatory breast cancer or advanced breast cancer with skin involvement

Risk of Recurrence after Nipple Sparing Mastectomy

According to research, when NSM with immediate reconstruction is performed, the risk of recurrence in the nipple area is low as long as individual characteristics of the tumor as taken into account. In a study of 944 women diagnosed with early-stage breast cancer who had NSM followed by immediate breast reconstruction, a recurrence rate of 4.1% was found during a follow-up time of 14 months to 15.4 years. This recurrence rate was for cancer in the nipple area and did not included recurrence in other areas near or away from the breast. For those who had a cancer recurrence, the characteristics of their initial cancer included being 1 :

  • multifocal
  • multicentric
  • hormone-receptor-negative and HER2-positive
  • high grade
  • large areas of DCIS in addition to the invasive cancer

In another study of 311 individuals who had NSM, a rate of recurrence of 5.5% was found during a median follow-up time of 51 months with no recurrences involving the nipple or areola that was kept intact.

The Next Steps for You

NSM offers women who are eligible for lumpectomy but looking to avoid radiation therapy a way to conserve their breast skin and nipple while still effectively treating their cancer. While NSM has a low rate of recurrence, it is important to keep in mind that very specific characteristics of the cancer contribute to this low rate. If you have been diagnosed with early-stage breast cancer, are considering reconstruction after mastectomy, and if keeping the form and structure of your breast is important to you, speak to your surgeon about nipple sparing mastectomy.

References

1. https://www.breastcancer.org/treatment/surgery/mastectomy/nipple-sparing

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