Journal time!
The latest May 2013 issue of Plastic and Reconstructive Surgery Journal was chock full of good studies on breast cancer reconstruction- tissue free flaps, tissue expander reconstruction, alloderm and other ADMs.
This article caught my eye in particular. “Nipple Sparing Mastectomy in Patients with a History of Reduction Mammaplasty or Mastopexy: How Safe Is It?” Not a catchy title to most, I know. But as we continue to refine how we do breast cancer reconstruction and more women choose to do prophylactic mastectomies (they have breast cancer in the other breast, a strong family history of breast cancer, or are BRCA positive), the use of nipple sparing mastectomies continues to rise. In a nipple sparing mastectomy you don’t cut out the nipple areola complex. You “core” out the breast tissue in the nipple. The aesthetic benefit is clear.
This study looks at nipple sparing mastectomies in women who have had prior breast reductions or lifts. Woah. When I read this title, I thought, “Wow. They even tried to keep the nipple?” When you do a lift or reduction you are moving the nipple areola complex around on a pedicle. The blood supply totally changes. To then go back and remove the pedicle and leave the nipple’s blood supply only coming from a skin bridge… it seems challenging to say the least.
The study is not large: 13 breasts were done. Average time since lift or reduction was over 4 years. Patients were average BMI and mean age was 46 (ie likely peri or premenopausal).
Findings? Nipple viability 100%.
This is a great study for me to see. Yes, there are caveats. These were younger women, normal BMI, out from their prior surgeries by years. But with our attempts to continue to refine and improve our reconstructions, nipple sparing mastectomies are a good tool in our toolbox, particularly for prophylactic mastectomies.