Where are the Skin Sparing Nipple Sparing Procedures Done?

TinaT · December 2012

Hi mermaidswim -

I'm surprised that U of M doesn't offer NSM!

New things are happening all the time so I am only making an educated guess about the term "skeletonizing". It is pretty routine for a spared nipple to be cored out from behind. In other words, the breast surgeon (BS) will try to remove as much tissue as possible from behind the nipple. This specimen is typically sent separately to the pathologist for immediate review during the mastectomy as well as more extensive review along with all the other tissues. If any cancer cells are seen in near proximity to the nipple during surgery it is usually removed at that time. If it initially looks clear, but the final pathology report shows cancer cells the nipple would likely be removed after the fact.

Mastectomy surgery removes blood vessels and nerves along with the breast tissue. Typically, there is some sensation around the base/periphery of the breast, but the closer to the the center of the breast the more numbness there is. Please don't get your hopes up that the nipples will feel anything like they do before MX. My BS has performed many NSM and initially told me that I could expect some "sensation", more like a knowledge that clothing is touching, etc. Some women report an actual uncomfortable sensation. That said, at my last visit with my BS she said that she has recently had a few patients reporting some more positive feedback 2-3 years after surgery. In other words, more sensation and less uncomfortable. So.....it's not impossible, but pretty rare for normal sensation to return, but hopefully some surgical tricks will be discovered along the way and someday this will be less of an issue. I knew this going into surgery and I had some problems along the way, but I'm still so happy I pursued NSM.

There is another thread called Nipple Sparing Mastectomy with Immediate Reconstruction that you might want to check. The "immediate" means that reconstruction is started at the time of MX so there is a mix of women there who have implants placed immediately as well as those who have tissue expanders placed for later implant placement.

I am sending you a PM with my personal info...

Kd6blk · December 2012

PRMA in San Antonio does them. So does the place in New Orleans. I opted out mainly due to increased risk of cancer. There is no guarantee you will maintain any feeling. I just got mine rebuilt. --lisa

PB22 · December 2012

mermaidswim,

If you scroll back there are several postings of surgeons in the Chicago area. If you have any questions on the procedure , feel free to PM me.

whitedove · January 2013

*BUMP

New Haven, Connecticut

St. Raphael's Hospital

Dr. Deborah Pan. (for Nipple Sparing Double Mastectomy)

In CT there are many doctors who do Skin Sparing/Nipple Sparing. Yale and St. Raphael's are the main hospitals I can recommend.

Good luck!

armywife199 · January 2013

Did anyone post of a BS in the Atlanta, GA area that performs NSM?

Chocolaterocks · January 2013

I had my surgery by Dr. Koch who is with the same group and here is an article they are sharing as there statistics and I hope it assists others. I have had only 1 surgery which is a good thing. Regards to all.

January SPECIALS

January 2013

ny group for plastic surgery cosmetic news

Focus on technique: one-stage implant-based breast reconstruction, C. Andrew Salzberg, M.D.

Focus on technique: one-stage implant-based breast reconstruction.Plast Reconstr Surg. 2012, Salzberg CA

Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 N. Saint Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, USA.

Dr. C. Andrew Salzberg

BACKGROUND:Direct-to-implant reconstruction with acellular dermal matrix has expanded the surgeon's repertoire and given the patient an opportunity to have a one-stage option after skin- or nipple-sparing mastectomy. The technique produces total implant coverage without the need for expansion, repeated operations, and delayed return of normal body image.

METHODS: In patients with adequate, good-quality mastectomy skin, a subpectoral pocket is created after mastectomy. The inferomedial pectoralis major muscle is elevated for implant placement. The acellular dermal matrix is sutured to the released inferior pole of the pectoralis muscle along its entire lower course and to the lateral mammary fold. The implant is introduced beneath the muscle-matrix layer, and the matrix is sutured to the inframammary fold at its desired position. Two suction drains are placed, one subpectorally and the other subcutaneously, through separate stab incisions, followed by skin closure.

RESULTS: Over a 10-year period, the author has performed this technique in 439 patients (790 breasts). Consistently low complication rates and good aesthetic outcomes have been obtained. Major complications, including implant loss (1.6 percent), skin necrosis requiring reoperation (1.3 percent), infection (1.1 percent), hematoma (0.6 percent), seroma (0.5 percent), and capsular contracture (0.5 percent), have remained at an incidence of less than 2 percent.

CONCLUSIONS: The author's 10-year results using acellular dermal matrix in direct-to-implant breast reconstructions demonstrate the effectiveness of the procedure, as well as its long-term safety and aesthetic benefits. Its success, however, relies on appropriate patient selection and specific intraoperative technique principles.

CyndiJW · January 2013

All I can say is I feel very fortunate to have been an excellent candidate for the Nipple-skin sparing surgery & reconstruction. It turned out great, but I do not, nor did I expect to, have any feeling in my nipples. It's strictly for aesthetics, as far as I am concerned. Too bad, but just happy not to have had to get them (nipples) removed & restructured. There certainly wouldn't have been any sensation then either, not to mention the extra surgeries & aesthetics.

Jen35 · January 2013

Hi I'm from Edmonton Alberta Canada and I'm also looking to have have a nipple sparring mastectomy with immediate reconstruction done. Im having a really hard time finding someone. Does anyone know of any surgeons that have some experience? Please help!

SpecialK · January 2013

Jen35 - check this link:

http://www2.canada.com/topics/bodyandhealth/story.html?id=7470944

kirklandgal · January 2013

Who was your PS? I live in Kirkland so Swedish would work for me. I was diagnosed earlier this week and the BS I saw this week didn't even mention that NSM existed - which should work for me since I have an occult primary (no detectable cancer in the breast) but cancer in my lymph nodes.

Crescent5 · January 2013

In Maine: BS Dr Melinda Molin, Mercy Hospital, Portland. Nipple and skin sparing MX. She and her staff are top notch. Feel free to PM me.

Jaegergirl · January 2013

I was a candidate for nipple sparing on my non-cancerous breast (left), but not on right. Since my nipples looked odd to begin with and would never match, I had my surgeon remove them both. Luckily she removed as little skin as possible. Love love love both of my doctors and highly recommend them.

In Ohio (approx 20 minutes east of Cleveland):

Dr. Karen Grassie, MD: General Surgeon, Lake Hospital Systems (Tripoint Medical Center, Concord)
Dr. Jennifer Greer, MD: Plastic Surgeon, Lake Hospital Sytems (Mentor)

tgilbert · January 2013

Looking for nipple-sparring in Pitts PA area?

netty46 · February 2013

Bernard Chang did a diep on meand left my old tissue behind. I had problems from beginning. Stomach busted from hip to hip. He left a hole in my breast in middle. Alot of necrosis developed at bottom. During 5 yrs I emailed I'm. I begged him to help cause it was getting painful. He always said it will get better it's not cancer. I went 5 yrs with no mammo on that breast cause he said I did not need it. Finally 2010 a surgeon in Florida tried to help me only to discover that dr Chang never removed the old tissue from my chest. Dr Chandler thought he did but then admitted to my doc on the phone he did not. I was sick with worry . Well here I am that necrotic piece turned up cancerous 12 yrs later chemo again, Masectomy, radiation, and severe sadness and depression. What did Chang say? Sorry to hear this but I'm sure your in good hands.

SLGrib · April 2013

I had my NSM done by Dr Kandace McGuire and immediate DIEP reconstruction by Dr Michael Gimbel at Magee Women's Hospital in Pittsburgh, PA

IMPORTANT: if you are interested in this procedure you must be proactive. It will not be "offered" to you, you have to ask.

thirdgenerationmomof2 · April 2013

Had NSM on 02/21/13 at GBMC Hospital in Baltimore, Md. My cancer was in the 12:00 position so my BS felt it was safe to do the NSBMX. Wonderful doctors! They did great work and I would highly recommend. Both my surgeons work together in the OR and have follow up visits in the same office. PM me if you would like details.

Dr. Lauren Schnapper, BS

Dr. Shari Slezak, PS

cateyz2 · June 2013

Had mine 5/31 at Northwest Community Hospital in Arlington Hts , Dr Michael Kinney was my BS and I highlt reccomend him. He also performs surguries at Alexian Brothers in Elk Grove Village

peepgirl · June 2013

In Pittsburgh, PA at UMPC Cranberry. Breast surgeon - Dr. Mary Beth Malay; Plastic surgeon - Dr. Anna Wooten. They work well together. Love them both.

HotPinkMess · June 2013

Atlanta, GA Dr. Diane Alexander at Artisan Breast Care

Daninayd · July 2013

I had my nsm on June 12, 2013. Dr. Nora Hansen from NW Memorial hospital performed the breast surgery and Dr. Neal Fine did the reconstruction. Both did a phenomenal job.

TinaT · July 2013

Hi Daninayd - So glad you had a good experience! In what city is NW Memorial Hospital located?

gonegirl · July 2013

Washington DC, George Washington University Hospital

BS Dr. Christine Teal

PS Dr. Joanna Lenert

CLYDAY · July 2013

UAB Birmingham. Dr. Krontiras and Dr. Fix. They did an awesome job!

TinaT · July 2013

San Francisco - Nima Grissom (breast surgeon) and Gabriel Kind (plastic surgeon) at California Pacific Medical Center. Both are amazing! Dr. Kind is an experienced vascular microsurgeon and offers all types of reconstruction (implants, DIEP, etc).

Pawprint · July 2013

Had mine done Fountain Valley, CA. My BS Dr. Jane Kakks. My PS Dr Andrew Smith.

Lucky777 · August 2013

I had mine done in Des Moines, IA

Dr Kostantinos Lekkas, I still have TEs in but I feel he has done an atrocious job. He says that everything can be fixed. My right one wss put in way too much to the side. My nipples point in different directions. Both are too low. He plans on lifting both. Creating more scars. He will have to do a lot of pocket work. I will have drains again. My husband says to try not to worry because he is not done yet. The pictures of TE that I have seen look way better than mine. I wanted the same size that I was, these are way bigger. I have to dress in layers b

TinaT · August 2013

Lucky777 - I understand that you're posting here to give others a heads up. While it's true that in some cases the TEs bear little resemblance to how things look when all is done you sound very unhappy and skeptical. Perhaps a second opinion could either confirm what your PS is telling you or will give you the "sign" that it's time to move on. Whippetmom (Breast Implant Sizing 101) keeps a list of surgeons and may have a name for someone in the Des Moines area. Or....perhaps someone on this list will chime in if they live near you and have had a good experience.

Best wishes...

ribz99 · December 2013

HELP!

I'm in NJ... I was referred to Sultan and Swistel for surgeons by my NY friends.

Really not sure what to do.... Any thoughts? You look so beautiful in your picture.

The more I read .....the more I am confused with my decision for surgery. I was Dx with DCIS in my rt breast. 6 cm. I now learned I have "extremely dense" breasts and that means I'm at a higher risk for BC in my future.

Lumpectomy vs mastectomy??? I read the thread on this site, but it did not make me feel any clearer with my decision. I was scheduled for a lumpectomy for Dec. 30th, but cancelled it and was opting for a DMX. I thought.....hey, why not get new perky breasts?

But it sounds like the road of recovery is more difficult than a "breast augmentation".

Please.... Any advise?

ribz99 · December 2013

HELP!

I'm in NJ... I was referred to Sultan and Swistel for surgeons by my NY friends.

Really not sure what to do.... Any thoughts? You look so beautiful in your picture.

The more I read .....the more I am confused with my decision for surgery. I was Dx with DCIS in my rt breast. 6 cm. I now learned I have "extremely dense" breasts and that means I'm at a higher risk for BC in my future.

Lumpectomy vs mastectomy??? I read the thread on this site, but it did not make me feel any clearer with my decision. I was scheduled for a lumpectomy for Dec. 30th, but cancelled it and was opting for a DMX. I thought.....hey, why not get new perky breasts?

But it sounds like the road of recovery is more difficult than a "breast augmentation".

Please.... Any advise?

sarahjane7374 · December 2013

Providence, RI - Women & Infants Hospital

BS - David Edmonson

PS - Pierre Michaud

Where are the Skin Sparing Nipple Sparing Procedures Done?

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