Nipple-sparing mastectomies?

Dear Julie,

With 5 cm tumor, you are right to be thinking of mastectomy upfront. As you can imagine, nipple sparing mastectomy leaves your nipple alone. But nipple is also a high risk part of the breast for developing BC. 1/2 inch is real close and after margins the nipple may not survive cosmetically. The procedure is going to leave NO sensation in the nipple. I recommend a skin sparing mastectomy with immediate start of reconstruction. In other words, get rid of the nips to reduce your risk fully. The nipples that PS' make look very realistic and while you will be nipple-less for a few months, in the end you will be satisfied.

Sorry babe.

I also had a tumor really close to the nipple and I was devastated that I had to lose the nipple. that played into my decision to have a mx despite a smallish tumor (1.7cm).

 9 months later I sometimes wish I had just had the lumpectomy cause I ended up having rads anyway. I felt like I'd end with a nippleless cratered lump in place of a breast, I'm not sure what could have been done recon wise.

I miss the sensation of the nipple, but I also miss the sensation of the rest of the breast skin. I had skin sparing TRAM immediately- I am happy with the results- but there is no sensation at all except around the edges.

it seems like we are put in such a rush at diagnosis to figure out this stuff out- its overwhelming to make these choices. If you can keep the nipple, I would try to. My tumor was subareola so it wasn't an option (or I was told it wasn't- I kinda wonder know- maybe I could have got a second opinon for peace of mind).

Makingway:

Thanks for the interesting info. Those are things I will check with my PS about (flat nipple and dent in chest). If there is anything else you can think of let me know.

I have already had a lumpectomy, I am having MX because of intensive LCIS and family history.

Marie

Yes distance from nipple is important and so are grade and stage.  You need to find a BS and PS who support the idea and work well together.  During surgery a pathologist will check the tissue from under your nipple and if it is clean they will allow you to keep your nipples. I did not have a nipple biopsy.

I had immediate reconstruction.  I had 600 cc filled to 125cc when I woke up.  We waited two weeks to begin fills and filled slowly 50cc a time--to 750cc and then we waited about 3 months before exchange to 800cc silicone implants.  We went slowly to keep an eye on the nipples. 

For me personally it made a HUGE difference in the process, when I first saw myself I looked like me but flatter, it was much less emotional for me. I'm grateful that I had this surgery.

Yes, they are flat, but I've grown used to it.  I had a hyster/ooph and I'm happy to have my nipples that breastfed my boys, since everything else is gone. 

However--there are some women who are not good candidates--- and other things to consider....

Very large breasted women whose breasts are really low--this is because you probably need a breast life and with that your nipples could die.  The MX cuts off all blood flow to the nipple except through the skin, so if you have a lift that moves the nipples they may not make it.  I was borderline and I am settling for my breasts being a little lower than if I had a lift.  With that said, I'm almost 50 and they are way perkier than they were before, but I think they have a natural looking shape for my age.  I have pictures on the forum, I will try and update because it has been 6 months and they look even better.

Yes, you no longer have sensation in your nipples, but you won't have sensation there anyway.  I have found that it has not changed my sex life--well my relationship has ended, but up until then, I knew when he was touching me and my mind was able to make the connection.  It wasn't like before, but the mind is the biggest sex organ we have, your memory will help.  My nipples respond to hot and cold.

Many feel that in the next decade NSMX will be the standard.

The first few days after surgery are important, you can still lose them do to loss of blood flow.  By the second day my PS was sure mine would be fine. 

Good Luck,

KarenW 

My incisions are from the outer part of my areolae towards my arm pit, it does not cross my breast, nor did it cut into the areolae.  My PS nor BS do IMF incisions as they both think they are more inclined to healing problems. Breast size should not impact blood supply through the skin at least I can think of no anatomical or scientifc reason this would occur.

 Overall my feeling was I would lose my nipples for sure, if I didn't try and keep them so, either I would try and keep them and it would work, or it wouldn't and I would be in the same place I would have been in if I didn't try.  I also felt like I was helping women behind me by giving my BS and PS the opportunity to get more experience with the procedure.

Best--Karen 

Sweety--I think it may have more to do with what I wrote about, larger breasted women tend to be "lower" especially if they breastfed, and so many want/need a lift along with reconstruction, which requires cutting around the nipples and moving them.  They do not always get enough blood supply after that.  So, I opted to hang a little lower, but I'm still way higher than I was before, than to have a lift and risk my nipples. Trade-offs, I guess. I think I have great looking breasts for a 50 year-old who breast fed for two years.

Hugs--Karen 

Julie--Check out Exchange City we have women who are doing all kinds of other things to create nipples, there are many options if that is what you want.  There are 258 pages and I think over 100,000 posts--everyone is welcome.

Ang was right--you go under not knowing what you are going to wake up with, and you have to be OK with that.

In the end I think Nagem is right people adjust.

Hugs--Karen 

I had a bi-lateral nipple sparing mastectomy Sept of 2008.  My tumor was on the left breast about 1/.4 inch from the aerola.  My margins were great and my nipple tissue remained alive and healthy on both sides.  Yes, a lot of the feeling is gone, but not totally.  I had simultaneous silicone implants.  Not even medical professionals know I have had a bi-lat mast by just looking.

Good luck in your choices.

Lisa