Hearing the words "you have breast cancer" can change everything in an instant. Along with processing the diagnosis, you may suddenly face many treatment decisions.
For some women, surgery will be an important part of their treatment plan. But today’s breast cancer surgery looks different from what it did decades ago. Advances in surgical techniques and breast reconstruction now give some women more options to preserve their natural appearance after surgery.
One of those options is nipple-sparing mastectomy.
“A nipple-sparing mastectomy allows surgeons to remove breast tissue while preserving the nipple, areola and much of the breast skin when it is considered safe,” said Brittany Murphy, MD, a breast surgical oncologist with Banner MD Anderson Cancer Center. “It’s one tool we have today to personalize breast cancer treatment.”
But nipple-sparing mastectomy is not right for everyone. Understanding how the procedure works, who may be a candidate and what to expect can help you have a more informed conversation with your care team.
What is a nipple-sparing mastectomy?
A nipple-sparing mastectomy removes all breast tissue but keeps the nipple, areola (the darker skin around the nipple) and breast skin intact.
During surgery, surgeons remove the breast tissue under the nipple while carefully keeping the outer appearance of the breast. Because most of the breast tissue is removed, breast reconstruction is usually part of the treatment plan. The goal is to safely remove cancer while keeping the breast looking as natural as possible.
“For some women, a nipple-sparing mastectomy can effectively treat cancer and help maintain a more natural look after reconstruction,” Dr. Murphy said. “It can also help boost confidence and improve body image after surgery.”
How is nipple-sparing mastectomy different from other mastectomy options?
When you hear the word “mastectomy,” it can mean different things depending on how much skin and tissue are removed. Your surgeon will recommend the approach that provides the safest cancer treatment while considering your goals.
Other common types of mastectomy include:
- Total or traditional mastectomy: A total mastectomy removes the entire breast, including the breast tissue, nipple, areola and overlying skin. Sometimes, a special closure called an aesthetic flat closure is done to make the chest look flat and avoid dents or extra tissue on the sides after the breast is removed.
- Skin-sparing mastectomy: A skin-sparing mastectomy removes the breast tissue, nipple and areola while preserving most of the breast skin. Keeping more of the breast skin can help create a more natural shape during reconstruction. However, the nipple itself is removed.
- Modified radical mastectomy: A modified radical mastectomy removes the entire breast and most of the lymph nodes under the arm. This procedure may be recommended when breast cancer has spread to nearby lymph nodes or when removing additional tissue is needed as part of treatment.
Who may be a good candidate for nipple-sparing mastectomy?
Not every woman with breast cancer will be a candidate for nipple-sparing mastectomy. Your surgeon will carefully evaluate your diagnosis and overall health to determine whether it is a safe option.
You might qualify for this procedure if you have:
- Early-stage breast cancer
- A tumor that is not close to the nipple
- Healthy breast skin and good blood flow to the nipple
- Overall good health and healing ability
- A high genetic risk and are considering preventive mastectomy
The location of the cancer is one of the most important factors.
“We look closely at the location of the tumor and how close it is to the nipple,” Dr. Murphy said. “If the cancer is too close to the nipple or involves the nipple itself, preserving the nipple may not be the safest option.”
Your breast size and shape can also influence whether nipple-sparing mastectomy is a good choice. Women with less sagging may have a better chance of preserving their nipples. However, this depends on the available reconstruction options.
Your overall health is also important. Since nipple-sparing mastectomy often involves reconstruction, your surgeon will consider factors that affect healing, such as:
- Smoking or nicotine use
- Uncontrolled diabetes
- Higher body mass index (BMI)
- Past radiation treatments
“Your health and how well you heal matter when deciding if this surgery is right for you,” Dr. Murphy said.
What should you expect after nipple-sparing mastectomy?
Many women wonder if keeping the nipple means their breast will feel the same afterward. Usually, it does not.
Changes in sensation
One common mistake about nipple-sparing mastectomy is thinking that keeping the nipple means keeping normal feeling.
"Holding onto the nipple doesn’t mean it will feel or work the same as before," said Dr. Murphy.
During surgery, nerves are cut or moved. Many women feel numbness in their breast or nipple afterward. Some notice tingling or changes as nerves heal. Over time, some feeling might come back but many women still feel less sensation.
Changes in appearance
A preserved nipple may maintain its position and shape but changes can happen. The color, appearance or position of the nipple may change during the healing process.
Your surgical team will monitor the nipple and breast skin after surgery to make sure they are healing properly.
How does breast reconstruction fit into nipple-sparing mastectomy?
Because breast tissue is removed, breast reconstruction is typically part of the treatment plan. Breast surgeons and plastic surgeons often work together to create a treatment plan that addresses both cancer treatment and your quality-of-life goals.
“The reconstruction plan is an important part of the conversation,” Dr. Murphy said. “We look at the patient’s goals, whether they may need radiation and what option will provide the best outcome for them.”
Some women choose immediate reconstruction, which begins during the same surgery as the mastectomy. Others choose delayed reconstruction or decide not to have reconstruction.
Reconstruction options may include:
- Implant-based reconstruction
- Flap reconstruction
- Goldilocks mastectomy
- Aesthetic flat closure
The goal is not to recreate the breast exactly as it was before but to create a result that feels comfortable and natural for you.
What is robotic-assisted nipple-sparing mastectomy?
Robotic-assisted nipple-sparing mastectomy is a newer surgical approach available to select patients.
Surgeons use a single-port robotic system to remove breast tissue through a smaller incision, often placed along the side of the breast. The goal is to safely remove breast tissue while preserving the nipple and breast skin when appropriate.
One potential advantage is that the incision may be less visible than with a traditional nipple-sparing mastectomy.
“I am really excited about this procedure because it may help minimize visible scarring for select patients,” Dr. Murphy said. “But we still have to achieve the same cancer-surgery goals.”
Researchers are also exploring whether robotic-assisted techniques and nerve-sparing methods can help patients keep their sensation. Although early results look promising, more research is needed.
It is important to remember that robotic-assisted surgery may not be suitable for everyone. Patients need to meet certain health and anatomy requirements. Access to this type of surgery is currently limited but will continue to expand. Traditional nipple-sparing mastectomy remains an important option.
Takeaway
Nipple-sparing mastectomy can be an option for some women facing breast cancer or choosing risk-reducing surgery. By preserving the nipple, areola and breast skin when it is safe, this approach may help create a more natural appearance after reconstruction.
But keeping the nipple is not the right choice for everyone. Your surgeon will consider your cancer type, tumor location, breast anatomy, overall health and personal goals to determine which surgery offers the best outcome for you.
You do not have to make this decision alone. Your breast cancer care team is here to help you understand your options and choose the approach that is right for you.
“Breast cancer feels urgent and you may feel like you need to make decisions quickly,” Dr. Murphy said. “But you do not have to navigate this alone. It takes a team to treat and care for the whole person.”
Find a Banner Health breast cancer specialist near you.
Frequently asked questions
Can you keep your nipple after breast cancer surgery?
Some people can keep their nipple during mastectomy but it depends on the cancer type, tumor location, anatomy and overall treatment plan.
Is nipple-sparing mastectomy safe?
It can be safe for select patients when the cancer is not near the nipple and the care team believes the approach is appropriate.
Who is a candidate for nipple-sparing mastectomy?
Candidates may include some people with early-stage breast cancer with tumors away from the nipple or high genetic risk who are considering preventive mastectomy.
Will I still have feeling in my nipple after nipple-sparing mastectomy?
Many people lose feeling in the nipple after surgery. Sensation may change or may not return.
Is robotic nipple-sparing mastectomy available to everyone?
No. Robotic-assisted nipple-sparing mastectomy is a newer option for select patients and access may be limited at first.
Is robotic-assisted mastectomy better than traditional nipple-sparing mastectomy?
Not necessarily. Robotic-assisted surgery may reduce visible scarring for some patients but traditional nipple-sparing mastectomy remains an important option. The safest choice depends on the patient and diagnosis.
Do you still need reconstruction after nipple-sparing mastectomy?
Most people have reconstruction with nipple-sparing mastectomy, either at the same time as surgery or later but some people may choose not to have reconstruction.
Should I get a second opinion before breast cancer surgery?
A second opinion can help you understand your options and feel more confident, especially if you are deciding between lumpectomy, mastectomy, nipple-sparing mastectomy, reconstruction or preventive surgery.
