I do tons of breast reductions and breast lifts. I love them. At our recent Aesthetic Plastic Surgery Meeting 2020 @ home (thank you quarantine!), the presenters were talking about doing nipple sparing mastectomies. What does a reduction or breast lift have to do with a mastectomy?
It is all about the nipple.
What do you do when the nipple is too low?
What do I mean? If you are doing a mastectomy (removing all of your breast tissue), as a prevention because you are high risk for cancer (BRCA or other genetic issue), the general surgeon can do a nipple sparing mastectomy. We love nipple sparing mastectomies, because they look so good. You keep your real original nipple. They remove the breast tissue and replace it with a breast implant. It gives a great breast reconstruction.
But now say you want to do this preventative nipple sparing mastectomy, but your breasts are droopy. So now doing a mastectomy alone isn’t okay because your nipple is too low. When we preserve the nipple during a nipple sparing mastectomy, where your nipple is now is where it would stay.
Which if you have breastfed three kids, have a C cup or higher, or are in your mid 40s or older, may mean your nipple is too low and too droopy. Uh oh. You want cute perky breast, don’t you?
So you need to move the nipple.
But you can’t move the nipple much during the mastectomy because then the nipple would die.
So what do you do?
When you are doing a prophylactic mastectomy (meaning you are high risk for cancer, but you DO NOT HAVE CANCER YET), you have time. The best way to achieve your goal of 1. perky breast and 2. alive nipple with less risk of a complication is to do a two stage procedure.
Stage one: Do a breast lift or breast reduction (if your ideal breast is to be lifted AND smaller) first.
Stage two: Do the nipple sparing mastectomy 3 to 6 months after the first stage.
Why?
Because when you reposition the nipple in a lift you interrupt the blood supply. It is safe to do this during a breast lift or breast reduction because you have breast tissue under the nipple which is giving blood supply to the nipple. In a mastectomy though you are removing all the breast tissue, so you are interrupting the blood supply even more —> so you can’t lift the nipple and do a mastectomy well at the same time.
When you do the lift or reduction BEFORE the mastectomy, and you let it heal for months, now the nipple is in a lifted, good position. The waiting time allows it to get a good new blood supply from the skin in its new happy position. Now when you do a nipple sparing mastectomy now the nipple is safer.