Two Common Breast Reconstruction Techniques
Most breast reconstruction patients I see and treat together with local Breast Surgeons are candidates for nipple-sparing mastectomy – a procedure designed to preserve the entire skin envelope of the breast during removal of the breast tissue inside, while also saving the nipple and areolar skin. A nipple-sparing mastectomy, or NSM, enables us to reconstruct the breast in a single combined procedure where I assist the Breast Surgeon with the mastectomy and then immediately reconstruct the breast using either an implant or the woman’s own tissue during the same operation. Usually, few or no additional major surgeries are required afterward, with the exception of minor adjustments. In order to ensure that no abnormal cells are left beneath the nipple, a separate specimen from under the nipple is sent to the Pathology lab to confirm it is safe to keep. If abnormal cells are ever found, the nipple can then be removed separately and reconstructed another time.
“Contraindications” to NSM (reasons when saving the nipple and areola is not recommended) include the presence of a large tumor, abnormal and/or cancerous cells are close to or immediately beneath the nipple, inflammatory breast cancer with significant skin involvement, or extremely large or droopy breasts where the nipple is near the bottom part of the breasts. However, we have developed a method to preserve the nipple-areolar complex in women who have breasts that are extremely large and/or “pendulous” (droopy).
For women who are not the traditional candidates for NSM and who wish to be reconstructed slightly smaller or perkier than their preoperative breast size, a breast reconstruction by lift can be performed. During this technique, a breast lift incision is used, the nipple and areolar complex is removed during surgery as a “free graft,” and it is reapplied to the breast in its new position at the end of the procedure. This avoids the need for a second, third, and sometimes fourth procedure to reconstruct the nipple at a later time, and the results are generally excellent, similar to a breast lift!