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 the most natural looking result of all the breast reconstructive procedures.
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 defined as “cosmetic surgery,” 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 over the implant. Good results can be anticipated thereafter. The post-operative appearance is generally superior to other forms of breast reconstruction.
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.