Nipple sparing mastectomy with ptosis

bethq

Hello, I have talked to a total of three surgeons about this and got three different answers. I have really deflated breasts with what I consider to be a good deal of ptosis with my nipple being slightly below the IMC (?) (forgot the acronym). One surgeon said I would be fine for nipple sparing, one said he wasn't sure and the one I am going with said she would do it but somehow didn't seem completely comfortable with it. My question is, what is the aesthetic outcome that they are afraid of? Is it that the nipple ends up on the bottom of the breast? I would rather not have that and have seen tattoos that look better than my current nipples. Any info is appreciated. My surgery is June 5. Thanks!

farmerlucy

beth - I asked my PS about doing areola sparing surgery, and she said she was going to do a lift also (I was a somewhat saggy  B - C) and that the areola would be in the wrong place. I trusted her to know what she was doing. I now have 3-d nipples and often forget they are not the real thing.

RainDew

Beth - 

I was in a sim position. I think it depends on where your cancer is, but my BS and PS were able to make all the incisions around my areola, cutting out a half moon of skin above therefore lifting the breast and putting nipples back in right place.

I am still in TE phase, so cannot speak to outcome yet, but have seen PS other word and it looked v good.

Rain

DiveCat

Surgeons will, as you seem to have figured out, look at where the nipple falls in relation to the IMF. There are a couple of reasons - if it is too far below you may end up with less desirable cosmetic results. It can be more difficult for the surgeons to work with shaping the breast when they need to worry about proper nipple placement. However, if you are not happy with the cosmetics, you can always have the nipple removed later. The second and more concerning one is the blood supply to the nipple may be weaker as it is a farther distance from your sternum/chest wall. This can result in loss of the nipple or other tissues (i.e. necrotic nipple). Generally the concerns kick in when you are looking at Grade 2 or 3 ptosis rather than Grade 1 ptosis...some surgeons are willing and able to work with more ptotic breasts than others though in nipple sparing. So even that is not a firm rule.

Some surgeons will do a lift either before the mastectomy, in a 2 stage procedure, and give it some time to heal, or at time of the mastectomy/recon. The reason for some not wanting to do it at the TIME of the mastectomy/recon is because the blood supply to the nipple will be compromised as is, and cutting near or around it when there is already so much other trauma to the tissues can increase risk of complications and risk of the nipple dying.