A study in the Plastic and Reconstructive Surgery Journal presents the possibility of nipple preservation not only in prophylactic mastectomy but in mastectomy for breast cancer:
Conclusions: Nipple-sparing mastectomy can be safe in properly selected patients. A subareolar biopsy can effectively identify nipple-areola complexes that may harbor cancerous cells. Ischemic complications resulting in nipple loss can be minimized, and long-term follow-up suggests that this technique deserves further investigation in properly selected patients.
Source: journals.lww.com/plasreconsurg/Fulltext/2011/11000
/Nipple_Sparing_Mastectomy_for_Prophylactic_and.1.aspx
This reminds me of a case in which I was involved ten years ago. Plastic surgeons tend to team up with general surgeons in the early stages of breast reconstruction. The general surgeon performs the mastectomy (breast removal) and the plastic surgeon picks up the pieces and tries to re-create the breast(s.) The call on the type of mastectomy to be performed is usually the general surgeon’s as they are generally in charge of getting the cancer out. I do try to negotiate (this is the way it feels) to preserve what we can for later use in reconstruction.
Most general surgeons take their task seriously and at times (at least in them minds of some plastic surgeons) “take too much.” While I do not blame them for this, it does make my job harder. They are trying to cure the patient. I want a wound that will heal and look as good as possible. These two ends work at odds with one another.
Well ten or so years ago, I was working with a fairly progressive general surgeon who had a patient with what was seen as early stage breast cancer. She wanted to keep her nipple after her mastectomy and this general surgeon was willing to do it. We discussed with her that this might increase the risk of the tumor coming back. She was willing to accept that risk. The surgery raised a few eyebrows at the hospital. I helped him with a skin sparing mastectomy and followed by doing a tissue-expander based breast reconstruction. She did very well.
While I think this new study helps support considering sparing the nipple in some mastectomy patients, I can’t help but wonder if many general surgeons will do it. The ugly beast called liability might just limit or prevent this.
The study only included fifty or so patients and they only followed them for three of four years, so it is not definitive. We will see how this develops over time.
Best Regards,
John Di Saia MD
