Skin and Nipple Sparing Mastectomy: Making Strides in True Breast Conservation

Written by: Christine G. Adamo 
Reviewed by: Dr. Richard Baxter

Are you familiar with all-in-one mastectomy and breast reconstruction surgery?

If you’ve been diagnosed with Stage I or Stage II breast cancers, which are not fixed to the skin or muscle, you’re no longer relegated to thinking that lumpectomy combined with radiation treatment is your only option for breast conservation. Skin and nipple sparing mastectomy followed by immediate breast reconstruction with breast implants:

• Provides more aesthetically-pleasing results
• Eliminates the need for anti-hormone therapy
• Is easier to complete, being an all-in-one procedure
• -&- Offers shorter recovery times than multi-stage reconstruction

Old Techniques in Breast Conservation

For years, women with early-stage cancer were told lumpectomy combined with radiation treatment – touted as “breast conserving therapy” – best served their breast cancer surgery needs. In December 2002, American Family Physician published “Breast-Conserving Surgery for Breast Cancer” in which Dr. Lecia M. Apantuku asserted that “conservative surgery (or lumpectomy) followed by breast irradiation (was) the preferred treatment for early-stage invasive breast cancer.”

She added: “Women diagnosed at early stages of invasive breast cancer have equivalent outcomes when they are treated by lumpectomy and radiation therapy or (mastectomy).” Yet, she confirmed that randomized trials showed “no difference in survival (rates) when mastectomy is compared with conservative surgery plus radiation for Stage I and Stage II breast cancer.”

She documented that a recurrence of cancer may emerge post-lumpectomy which might require a mastectomy after all, if not followed by irradiation. Recurrence rates in women not receiving radiation treatment post-lumpectomy, in fact, were found to be higher.

New Strides in Breast Conservation

Conserving your breast tissue and surrounding skin and nipple area is of the utmost importance. Today’s skin and nipple sparing mastectomy combined with immediate breast implant-based breast reconstruction is an all-in-one procedure performed by a board-certified plastic surgeon which reinforces that notion.

During this procedure, breast tissue is removed from both breasts while leaving your surrounding skin and nipple areola complex intact. Lost tissue is then immediately replaced with breast implants which are appropriate to your body type. The advantages of choosing skin and nipple sparing mastectomy over traditional lumpectomy and radiation therapy include:

• The relief of not suffering through radiation treatment or its adverse effects
• The ability to side step estrogen blocking treatment following lumpectomy
• The assurance that you will have well-balanced, natural-looking breasts
• The benefit of quicker treatment time and a shorter recovery period

Achieving high levels of conservation requires knowledge and skill. Your plastic surgeon should be able to provide you with a detailed description of the components making up skin and nipple sparing mastectomy and immediate breast implant-based breast reconstruction during a consultation. Those include acellular dermal matrix grafts, which are typically used to create an internal bra that provides support for replacement breast tissue and aids breast reconstruction.

Old vs. New – A Comparison of Options

The risks associated with radiation treatment provide reason enough to know your options. As the American Cancer Society notes, radiation can cause: Skin discoloration, fatigue, diarrhea and difficulty eating and/or swallowing. Additional unpleasant radiation therapy side effects include: Skin burns, radiodermatitis (or radiation dermatitis) and weeks-long, nearly daily treatment at oncology centers.

What’s more, a traditional lumpectomy can change your breasts significantly – resulting in deformities and/or breast asymmetry. To plastic surgeons, that’s hardly an advancement in breast conservation. By exploring skin and nipple sparing mastectomy and immediate, implant-based breast reconstruction you can make a more confident decision about which option is best for you.

Other Downsides to Traditional Treatment

Women with receptor-positive or hormone sensitive cancers – in which estrogen fuels tumor growth and chance of recurrence is higher – are often prescribed anti-estrogen drugs like tamoxifen (sometimes referred to by the brand name Nolvadex®).

The National Cancer Institute says serious side effects of anti-estrogen treatment include:

• Blood clots
• Strokes
• Uterine Cancer
• Cataracts

The NCI also cites side effects which mimic menopause symptoms: Hot flashes, vaginal dryness, joint pain and leg cramps. While that may sound scary, there is good news.

Skin and nipple sparing mastectomy followed by immediate, implant-based breast reconstruction – a new way of thinking about breast conservation – does not require anti-estrogen drug treatment. As such, it helps you side step the unpleasant side effects outlined above. There’s no medication to take. There are no radiation treatments to suffer through.

After one operation, you’re on your way to recovery.

Added Benefits of New Advancements

Published in the April 2011 edition of Plastic and Reconstructive Surgery, the journal article “Immediate Placement of Implants in Breast Reconstruction: Patient Selection and Outcomes” sums up the results of a study conducted by six representatives of the Plastic and Reconstructive Surgery division of UCLA’s David Geffen School of Medicine.

The group concluded that “immediate implant-based breast reconstruction is a safe and viable option that can provide a very good aesthetic result in appropriately selected candidates.” That includes individuals requiring unilateral (left or right) and bilateral (left and right) breast reconstruction. Caution and counseling was suggested for patients whose medical histories indicated – among other things – prior radiation treatment.

Why Didn’t My Doctor Recommend This Option?

As human beings, we’re creatures of habit. Treatment via lumpectomy and radiation is more commonly referred to as “breast conserving therapy” and makes sense when it’s all you know. But, the outcomes afforded by skin and nipple sparing mastectomy followed by immediate, breast reconstruction with breast implants can be infinitely more rewarding.

This all-in-one approach to treatment is revolutionary. Surgeons are not exempt from the pressure exerted by a creature-of-habit mentality. But, those who cling tightly to traditional procedures do you a disservice. Lacking knowledge and hesitant to move their practice into modern times, they limit your ability to get the quality of care – and outcomes – you deserve.

How Do I Advocate on My Own Behalf?

Receiving a diagnosis of breast cancer can be unsettling. Receiving a recommendation to undergo a mastectomy or lumpectomy only makes matters worse. The thought of challenging your doctor (at a time when you’d prefer to be taken by the hand and led seamlessly through that process) can seem puzzling.

Become your own breast care advocate. Find a qualified plastic surgeon able to help you understand your options. Remember that making a decision about which course of treatment to pursue is highly personal and that, despite feeling overwhelmed, you don’t need to rush to a decision.

In the truest sense, the ultimate goal of “breast conserving therapy” should be to address all of your early-stage breast cancer surgery concerns in as few procedures – and with as few side effects – as possible.