Nipple sparing vs. nipple reconstruction

EminGA2018

I’m scheduled for BMX with (hopefully) straight to implant reconstruction on August 24th. My plastic surgeon has recommended nipple removal and reconstruction for aesthetic reasons. He is concerned with “nipple drift”.

I’m okay with nipple removal as my cancer is ductal and I feel that gives me more protection from recurrence. My surgical oncologist hasn’t discussed that aspect of the surgery with me. I have requested another appointment to discuss it.

does anyone have advice on choosing one over the other?

Thank you

SpecialK

I initially had a skin and nipple sparing bi-lateral mastectomy. Due to a bunch of unforeseen surgery I ended up with nipple asymmetry. Eventually I had both removed several years later during subsequent implant downsizing surgeries. While I was happy at the beginning to see my own nipples because it made things seem more familiar I eventually realized they are just decorations since you can't feel them, they don't function because everything underneath them is removed, and for some there is the need for always wearing a bra, etc. If I had it to do over I might have opted for 3D tattoos, but I also liked the IMF incision with the nipple sparing surgery rather than the horizontal traditional mastectomy incision. I have some friends who opted for nipple reconstruction, but have not liked the result, which also involves another surgery. In your shoes I might roll the dice and try the nipple sparing with direct to implant and see what happens, you always have the option of removing the nipples later and reconstructing nipples or doing tattoos. As far as the nipple removal for recurrence risk reduction the studies done on sparing surgery has shown it is safe if you are a good candidate - the cancer needs to be a certain distance from the nipple areola complex. During surgery the tissue from under the nipple is sent to pathology and checked also. Good luck!

serendipity09

Hi EminGA2018!

I had a skin sparring BMX with immediate reconstruction with TE's. Nipple sparring was not an option for me due to their size, not because of the tumor. Like SpecialK, I too know a couple ladies who chose to have nipple reconstruction who are not happy with it, but I know some else who loves the way they look. I just recently had my exchange to implants and was diagnosed with a recurrence. My doctors and I were blindsided, as the new tumor grew exactly where the original tumor was; it was never a conversation I thought to have with my doctor. Once this is new treat plan is all done and over with and I have my revisions, I will get the 3D tattoos. I think they look more natural than the reconstructed nipples I've seen, I won't have to wear a bra or "nipple covers" if I don't want to with the tattoos; with nipple reconstruction the nipples will always be erect, which really isn't a big deal I guess and I really don't want to have another surgery if it's not necessary. I do know I want to have the effect of having nipples. Hope that makes sense. Ultimately it's going to be your decision and I'm sure whatever you chose will be great! Good luck and praying that everything goes well for you on the 24th!

SummerAngel

I agree that it might be a good idea to try nipple sparing at first as you can always remove them later on. If your surgeon is stating that he's concerned, though, that's something to keep in mind. It most likely means he's had trouble with it before. You might want to interview other surgeons. I wasn't able to have nipple-sparing as the tumor in my right breast was too close to the nipple. I interviewed a few surgeons before my surgery and one surgeon was adamant that nipple reconstruction "never worked" and he only did 3D tattoos. Another often did reconstruction and showed me photos of his results - great photos. I went with him and had nipple reconstruction AND 3D tattoos and am extremely happy with the combination. My goal was to get them looking as real as possible and they definitely do.

EminGA2018

Ivy09- I'm sorry to hear about your recurrence. That setback must have been so stressful after you have come so far! Sending you hugs. thanks for your input on nipple reconstruction. I am amazed at how realistic those 3D tattoos can look. I may end up doing a reconstruction and tattoo. My SO has been really hard to get a hold of and provides no real guidance on that.

EminGA2018

Special K and Summer Angel - I'll definitely talk to someone at my SOs practice about whether nipple sparing is an option for me. I know I have an area of cancer behind my left nipple but I'm not sure how far. I never really considered going back in and removing them later. Thanks for letting me know that is an option.

I had a 2-hour consult with my surgical oncologist and a 2-hour consult with the plastic surgeon in the same week and then someone called me with my surgery date. I feel I could definitely use more information. My plastic surgeon is definitely more interested in nipple removal from the standpoint of a final aesthetic result. Given my timeline and available surgeons in the area..I feel like I don't have time to look for another plastic surgeon. He does good work.My SO is a little non-communicative but the best reviewed in the area.

My original surgeon and radiologist biopsied the wrong spot…gave me a false positive and cost me 8 months of cancer fighting time….then missed two additional areas of cancer

Ibis

I had 2 nipple sparing mastectomies a year apart with implants. Now, 3 years later, the right has DCIS in the nipple area. I had met the criteria fo NSMX and the shaved nipple margins were clear after surgery. Now the nipple and areola will need to be removed. My concern is there's not much skin to stretch for closure after the nipple is removed. Haven't met with the breast surgeon yet so I'm know more after that. This was discovered by an MRI to check for implant integrity. The plastic surgeon gave me the results and recommended focusing on removing the cancer and treatment if necessary, then contact him if I want more work done. The thing is I only want one surgery.