Nipple Sparing Mastectomy Saves Lives and External Breast

Oct. 27, 2011— -- Thirty-three-year-old Laura Scott sat in her doctor's office in shock.

Her physicians had just diagnosed her with stage 1 invasive breast cancer, after weeks of telling the young mom that they didn't believe the lump she'd found during a breast self-exam was cancerous. It didn't feel like cancer, they said. She did not have a family history of the disease or a genetic mutation. And she was young.

But they were wrong, and Scott was left to weigh her treatment options. She could choose a lumpectomy, but she wasn't willing to take the 8 to 12 percent chance of cancer recurrence. With two young daughters and a husband at home, she "planned on being around for a while."

Instead, she chose a bilateral mastectomy. And because the lump in her breast was not near her nipple, she could choose a procedure called nipple sparing mastectomy, or NSM.

"It became very clear early on that I wanted to go the most aggressive route," said Scott. "Still, It was incredibly scary to think of losing my breasts. As a woman, they certainly don't define you, but they are a part of you. Not to have them at my age was just unthinkable."

But she went ahead with the bilateral NSM, which entails the removal of the breast tissue, while keeping most of the breast's exterior, including the breast skin and nipple areola complex, intact. She also opted for immediate breast reconstruction.

"I woke up and I didn't even want to look," said Scott, who lives in Arlington, Va. "But when I did, I couldn't believe it. I looked normal, and that's all I could have asked for."

Now a new study published in the journal Plastic and Reconstructive Surgery found that some women who need a lumpectomy or mastectomy have another safe option with NSM, which doctors said offered women breasts with a more natural look and feel when compared to other forms of mastectomy.

"Nipple sparing mastectomy as compared to other forms of mastectomy is becoming more common, and the surgery is usually successful in terms of achieving good breast reconstruction with a low risk of complications," said Dr. Scott Spear, chairman of the department of plastic surgery at Georgetown University Hospital and co-author of the study. "There's a low risk of finding breast cancer or disease beneath the nipple in those patients who are offered nipple sparing mastectomy."

One of the main concerns with keeping the skin and nipple intact is the potential for cancer recurrence in the future. With that in mind, researchers reviewed the 169 NSM surgeries performed over 20 years at Georgetown University Hospital. They found there were no cancer recurrences and no new cancers on average for two and a half years after women underwent the procedure.

"There have been psychological studies to assess how women feel after having nipple sparing surgery compared to when the nipples have been removed," said Spear. "There is a dramatic difference shown that women are psychologically better off, in terms of self-esteem and sense of self, than those who have had the nipple removed. One of the appeals to this surgery is that you don't have to remove the breast skin and the nipple so it's similar to breast conservation."

But not every woman who needs a mastectomy is eligible for NSM. The procedure is dependent on several factors, including the size of the cancer, the size of the breast and the location of the cancer within the breast.