New Option in Autologous Breast Reconstruction

Nipple-sparing mastectomy uses patient’s own tissue

“Nipple-sparing” procedures are a relatively new but increasingly popular option for women undergoing reconstructive breast surgery. In these procedures, the surgeon preserves the nipple-areola complex (NAC) for immediate use. Although technically challenging and requiring careful planning, a nipple-sparing mastectomy with autologous (using one’s own tissue) breast reconstruction can be very successful, according to a recent article in Plastic and Reconstructive Surgery. Previous reports on this technique focused on women having reconstruction with implants.

The 51 women in the study were screened to assure that they were good candidates for autologous breast reconstruction. About two-thirds had preventive mastectomies; most had BRCA1/2 mutations, placing them at high genetic risk for breast cancer. The remaining women underwent nipple-sparing mastectomy after initial examination suggested no cancer was found in the NAC area.

Although results were good, the complication of tissue death (necrosis) of the NAC used for reconstruction occurred in about 13 percent of patients. This complication appeared to be more common in women with a history of smoking. In two women, evidence of cancer involvement was discovered under the NAC after surgery, making it impossible to preserve the nipple.

Nipple-sparing procedures offer promise to women wanting to achieve a more natural look. “There have been psychological studies to assess how women feel after having nipple sparing surgery compared to when the nipples have been removed,” observes Dr. Scott Spear, chair of the department of plastic surgery at Georgetown University Hospital in Washington, D.C. Women with the surgery are psychologically better off and have higher self-esteem than those who have had the nipple removed, he continues.

But not every woman is eligible. Several factors must be considered — the size of the breast and the cancer itself as well as the location of the cancer. And because it’s so new, it’s important to find a physician well-versed and experienced in type of surgery, with close cooperation and communication between patient and surgeon.

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