Breast surgeons only remove breast tissue in nipple-sparing mastectomy. The patient's breast skin, areola and nipple remain. An advantage of this procedure is that the breast remains more cosmetically attractive. A disadvantage of nipple-sparing mastectomy is that the nipple and areola lose sensation.
Nipple-sparing mastectomy may be available for patients whose tumor is small and positioned away from the nipple. It may also be an option for patients undergoing preventive mastectomy or patients with ductal carcinoma in situ (a very early stage of cancer).
Nipple-sparing mastectomy is often performed when breast removal and reconstruction are completed during the same operation. If an axillary dissection or a sentinel lymph node biopsy is necessary, another incision is usually made in the armpit area.
A nipple-sparing mastectomy with breast reconstruction takes two to eight hours, depending on the type of breast reconstruction performed.
After nipple-sparing mastectomy, small tubes are sewn into place in the breast area to draw off fluids. The ends of these drains are attached to a pocket-sized suction device. Patients are instructed in the care and monitoring of the drainage until the drains are removed, several days after surgery.
The hospital stay after nipple-sparing mastectomy and reconstruction may be one to five nights.
The pain level following nipple-sparing mastectomy is generally greater than the pain level following a simple or total mastectomy. Patients often use prescription pain medication for the first one or two weeks following surgery and then use an over-the-counter pain reliever as needed.
Numbness may occur under the arm if an axillary dissection (removal of lymph nodes under the hollow of the arm) is performed. Some numbness may fade over time.
Cancer surgery is emotionally draining and physically taxing. Patients are advised to expect fatigue and plan a light schedule that includes daily naps for the weeks following nipple-sparing mastectomy.