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Nipple-Sparing Mastectomy Is Possible

Surgeon Calls It a Viable Option for Certain Breast Cancer Patients
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WebMD Health News

Feb. 12, 2004 -- Lisa Solarz remembers feeling completely numb two years ago when told she would have to have her breast removed. Diagnosed with breast cancer, the Ohio child services official assumed she was a candidate for a breast-sparing lumpectomy, but her cancer had spread too far.

"It was all pretty overwhelming," she tells WebMD. "I was 39 at the time, with no history of breast cancer in my family. It was a lot to take in."

Luckily, her doctors were able to reconstruct her breast with both its original skin and nipple, in a procedure pioneered by Cleveland Clinic surgeon Joseph P. Crowe, MD. Solarz, who today refers to herself not as a breast cancer patient but as a survivor, says she is thrilled with the results.

A Viable Option for Some ...

The most commonly performed reconstruction surgery following total mastectomy involves taking tissue from the abdominal area to remake the breast. Surgery that spares the skin surrounding the removed breast is a relatively new option, but the nipple and areola are almost always removed with the breast tissue because of concerns that they could harbor stray cancer cells.

Crowe says nipple-saving surgery is a viable option for a select group of mastectomy patients, and he reports on his experience performing such surgeries in the Feb. 9 issue of the journal Archives of Surgery.

The surgery involves virtually hollowing out the nipple area, examining remaining tissue for evidence of cancer at the time of surgery, and immediately reconstructing the tissue back to the skin of the breast. Women who have small tumors, and those who chose total mastectomy to lower their risk of developing future tumors, may be good candidates for the procedure.

Of the 48 nipple-sparing mastectomies Crowe performed with colleagues between late 2001 and mid 2003, 45 were successful, resulting in a viable tissue when there was an immediate reconstruction of the nipple and areola. In the remaining three cases, blood flow problems resulted in tissue death and in the partial loss of the nipple-areola.

Patients ranged from age 29 to 72, with the mean age being 43 years. Most of the women in the study had small tumors. A few did not have cancer at all but were having their breasts removed because they had a strong family history of breast cancer.

... But Not for Others

Crowe says women with large tumors or tumors that are located close to the nipple are not candidates for nipple-sparing surgery. Women with very large breasts tend to be poor candidates because nipple displacement is a problem.

To save the nipple area, breast reconstruction must be performed immediately following the mastectomy, meaning that the cancer surgeon and plastic surgeon must work as a team.

Memorial Sloan-Kettering Cancer Center plastic surgeon Joseph J. Disa, MD, FACS, says patients who are interested in this procedure or any reconstruction following a mastectomy should meet with a board-certified plastic surgeon before their cancer surgery.

Reconstructive options are better for women who have immediate reconstruction after mastectomy he tells WebMD. "Skin-sparing surgery is not an option when reconstruction surgery is delayed, and nipple-sparing surgery certainly isn't."

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