Women who make the decision to have breast reconstruction surgery after a mastectomy enjoy both aesthetic and psychological benefits and changes. The reconstructed breasts can have the same look as the original breasts while also giving the patient an improved self-image and greater confidence in their appearance. However, there are times when a person can experience issues with their nipples after a breast reconstruction procedure and these issues can include pain and a lack of sensitivity to the nipples. Keep reading this informative article to learn more about options that help to maintain nipple sensation.
In addition to the choice of having a mastectomy, patients can also have a lumpectomy where only the cancerous tumor and a small portion of the surrounding tissue is removed by the surgeon. For many years, a mastectomy involved the removal of the entire nipple due to the fact that the nipple has ducts. There are times when breast cancer starts in the ducts that line the nipple and the breast.
In order to make a change in how a mastectomy is performed, a number of surgeons started to research and perform nipple-sparing mastectomy in the early 2000s. Just like the name suggests, the surgery is able to save both the nipple and the skin. This is especially helpful in cases where the breast cancer experienced by the patient is not very close to the nipple. There is an aesthetic benefit to this technique since the nipple is one of the most prominent parts of the breast. Saving the nipple will likely give a better look than one that is created surgically while also reducing the psychological impact of having the nipple removed from the breast.
The decision to have surgery that spares the nipple can be an appropriate choice if the surgeon determines it is safe in terms of a small chance of cancer recurrence. The patient might not be an ideal candidate for this treatment option if the breast cancer tumor is close to the nipple or if the cancer involves the nipple.
It has been reported that when the type of breast cancer, along with the location of the breast cancer, were considered in the final decision to have a mastectomy that spares the nipple, the rates of recurrence for breast cancer were low after the procedure. This result was revealed in a study published in JAMA Surgery in 2019.
A person with droopy breasts might not be an ideal candidate since the sagging of the breasts makes it harder to get an ideal aesthetic result. Patients should consider having a breast lift before deciding to have surgery that spares the nipple.
If the nipple of the patient needs to be removed by the surgeon, nipple reconstruction surgery will be performed a few months after breast reconstruction surgery. The reconstruction surgery normally involves the creation of a nipple out of the skin that already exists in the area of the breast where the nipple should be located. The surgeon will make precise cuts on the skin so they can fold it into a small “nub” that will become the new nipple. The surgeon can also create a new areola which is the dark circle that is located around the nipple. The new areola can be created by performing a skin graft.
Patients do need to know that the new nipple will not have the same amount of sensation as the original nipple. It will feel like a nipple to a person that touches it, but the nipple will not regain its sensation after the surgery. The nipple-sparing mastectomy can save the nipple but the nerves in the breast tissue that are removed are permanently removed. There are some cases where the sensation in the nipple and the breast can slowly regenerate, but it will not be at the same level as pre-surgery sensation.
If a patient does not want to have a nipple surgically created, they have the option of a 3D nipple tattoo that is placed flat on the body while having an appearance of the dimension of a nipple.
There is a procedure that makes it possible for female patients to retain a level of erogenous sensation in the nipples and it is known as nipple nerve reconstruction. In this surgical procedure, the surgeon reconstructs the nerve that supplies the sensation to the nipple and skin. The reconstruction process happens during the nipple-sparing mastectomy as a way to try and restore the feeling of the breast and nipple.
While this is a welcome idea on the part of patients, further research needs to be conducted to determine if there is enough compelling evidence to show there is a benefit to this step. There are studies being conducted across the country regarding sensory return and the outcomes reported by patients when it comes to sensory return.
In addition, insurance plans will normally pay for breast reconstruction after a mastectomy but nipple nerve reconstruction is considered to be an experimental procedure they will not cover.
- MA
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