Nipple sparing mastectomy and breast reconstruction
What is it?
Nipple-sparing mastectomy (NSM) is a type of conservative mastectomy that means the removal of the whole mammary gland while preserving skin envelope, areola and nipple. Breast reconstruction is performed during the same procedure with implants replacing the gland removed. To date, NSM offers the best cosmetic result after mastectomy and pre-pectoral breast reconstruction is emerging as a promising technique that allows excellent aesthetic outcomes and fast recovery for the patient. In our hospital we offer NSM followed by immediate pre-pectoral implant-based reconstruction whenever possible to patients who are diagnosed with breast cancer or women who are at high-risk for developing breast cancer and wish to have their risk reduced.
When is this procedure indicated?
NSM followed by prepectoral implant-based reconstruction is indicated as a therapeutic procedure in patients who are diagnosed with breast cancer and as a risk-reducing procedure in women at high-risk for developing a breast cancer in the future due to genetic mutations or personal characteristics (i.e. previous irradiation, contralateral breast cancer diagnosis.
How is it performed?
NSM with prepectoral reconstruction is performed under general anesthesia and is carried out by removing all the breast tissue and leaving the nipple, the areola and the breast skin. In patients with breast cancer the tissue beneath the nipple is checked for breast cancer and if cancer is detected the nipple-areola complex is excised. Breast implants are placed in the pocket where the glandular tissue was removed just over the pectoralis major without impairing the muscle neither prolonging surgery with a more invasive procedure. On drain per breast is placed.
Recovery
Recovery after NSM and prepectoral implant-based breast reconstruction is relatively fast as the muscle remains "untouched". The patient is generally discharged during the second postoperative day and within two weeks the drains are usually removed.
Short-term complications
Intraoperative or postoperative bleeding, infection, dehiscence, need for re-intervention due to bleeding or positive margins, keloids, breast asymmetry, low satisfaction for cosmetic results, necrosis of the skin or of the nipple-areola complex, seroma eventually requiring needle aspiration, local pain, capsular contracture, breast implant-associated anaplastic large cell lymphoma.
Where do we treat it?
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