Mastectomy refers to removal of the whole breast. It may also include lymph node removal in the armpit area to determine whether the cancer has spread from the breast to your body’s lymphatic system. There are five different types of mastectomy: Simple (also known as Total), Modified Radical, Radical, Partial, and Nipple-Sparing (also known as Subcutaneous). During Nipple-Sparing Mastectomy (NSM), all of the breast tissue is removed, but the breast skin envelope is preserved and the nipple is left alone. NSM represents the latest evolution in mastectomy technique.
During your consultation visit to his office, Dr. Kim will discuss whether or not you are a suitable candidate for the NSM procedure. Appropriate candidates include women seeking prophylactic (preventive) mastectomy, or those who have DCIS located several centimeters away from the nipple or a small cancer. Often, women who have diabetes, are smokers, or are prone to poor healing (such as if they had previous radiation treatment) are not candidates.
When combined with immediate breast reconstruction (breast reconstruction at the time of mastectomy) NSM provides superior cosmetic results without compromising patients’ cancer treatment. NSM can be performed in conjunction with any type of breast reconstruction. A major benefit of NSM is that it allows the patient to avoid an additional surgery for nipple reconstruction and the subsequent nipple tattooing procedure. There is also data to suggest that women experience improved body image and self-esteem with NSM; although plastic surgeons can reconstruct a nipple, it often loses projection over time and is not quite as natural looking as what a woman was born with.
It is important to note that although the nipple theoretically will retain sensation after nipple-sparing mastectomy, it is possible to lose feeling. However, many women report at least partial sensation. There is also the possibility that a NSM patient may lose her nipple eventually. If there is an interrupted or inadequate blood supply to the nipple after the mastectomy, the nipple may necrose and need to be removed.
Importantly, the risk of breast cancer recurrence in women who have NSM is similar to that in women who undergo other types of mastectomy. The risk of recurrent breast cancer after any mastectomy modality is very low but is not zero, and NSM patients are not putting themselves at higher risk.