Nipple-Sparing vs Just Skin-Sparing

NicInTexas

I am struggling to find any meaningful comparisons between sparing or not sparing nipples during mastectomy. I've read as much as I could find on this forum/site, but maybe I am not looking in the right place. I am scheduled to have a bilateral mastectomy in about 3 weeks, and the surgeon says this decision is up to me. They will prepare for both just in case they find anything, but they couldn't provide me with any cons to nipple-sparing unless there was not enough margin between the mass and the nipple.

I don't want to leave something there that might come back to haunt me later (especially as this is my second go round), but I don't feel like I fully understand the pros and cons. Maybe there aren't any. I expect that I will have no feeling in my breast and nipple either way.

I had radiation on my right breast, so that nipple is a different color than the untreated one on my left.

Any thoughts or sources of information?

exbrnxgrl

Hi nic,

I originally had a skin sparing and nipple sparing bmx. The pathology report determined that the margins were tooclose on my left breast so that nipple was later removed. Now I have one of each. You are correct about not having any sensation in saved nipples or the breast itself since all breast tissue is removed. You may have some skin sensation. I had implant recon so the only difference is that the breast with a nipple has more projection but it is not noticeable in clothing. As far as worrying about disease, if the path report shows enough of a clean margin then that is considered acceptable. It is impossible, even with a mx, to guarantee removal of every tiny cancer cell. So, theoretically, the more tissue and skin one removes, the lower the chances of stray cells remaining behind. However, nipple sparing surgery is fairly common and if your surgeon feels like the location of your bc makes nipple sparing possible, I think that choosing that shouldn't be a cause for concern. Take care.

NicInTexas

Thanks exbmxgirl! I just really wanted to make sure there was nothing obvious I was missing in this decision making process. It sounds like not. There are so many choices to make along the way!

typhoon

Hi Nic - I had a nipple- and skin-sparing BMX last December. My surgeon was very confident that the tumors were sufficiently distant from the nipple, but did remove all the tissue behind the nipple and have it biopsied anyway (it was all clear). For whatever reason, I've actually regained some skin sensation - including nipples - in both breasts, except for a small patch at the top of each breast. Obviously not as sensitive as before the BMX, but I'll take it! Good luck with your decision and your surgery!

NicInTexas

Thanks typhoon. I'm starting to feel more comfortable with the nipple-sparing BMX (with the understanding that this could change based on margins, etc).