Breast Surgeons Work on Saving Nipple
One obstacle to breast reconstruction after a mastectomy is doctors’ reluctance to salvage the original nipple. Now researchers are testing the idea that this may sometimes be possible.
During a mastectomy, doctors may painstakingly preserve the skin of the breast, but they almost always discard the nipple and areola, leaving plastic surgeons to create a look-alike replacement.
The reason is fear the nipple will harbor cancer. All parts of the breast connect to the nipple, so the tumor may extend there too. Studies done in the 1970s and ‘80s found the nipple is involved in between 8% and 50% of breast cancer cases.
Nevertheless, many cancer patients would like to preserve the nipple as well as the rest of the surface of the breast. Now doctors at the University of Texas M.D. Anderson Cancer Center in Dallas have cautiously begun an experiment to see if this can be done safely. So far, they have retained the nipples of eight women who underwent skin-sparing mastectomies.
Instead of severing the nipple completely, surgeons make a half-moon cut around the top of the areola and use this opening to hollow out the breast. Then they fill the breast and stitch the nipple back in place.
“It just blows you away how good this looks,” says Dr. Geoffrey Robb, a plastic surgeon.
Unlike those with reconstructed nipples, these women retain some sensation.
Doctors felt justified in trying this approach after reviewing the cases of 326 mastectomy patients at the hospital in the early ‘90s. They found that the nipple is most likely to contain hidden cancer when the primary tumor lies in the central part of the breast or if the breast contains more than one obvious tumor.
Dr. Christine Laronga of M.D. Anderson says a likely candidate has a small single tumor away from the center of the breast and no sign the cancer has spread to the nipple or lymph nodes. Her study suggests that in such cases there is less than a 2% chance that the nipple is cancerous.
She says that even if cancer is left in the reattached nipple, it should be easy to spot early during follow-up exams, when it can be removed.
