Let’s give them a chance

The nipples … I decided to keep them.

I met with Dr. K to talk about a few things I wanted to revisit before we sealed the deal. One of them being: whether or not my mastectomy will be nipple-sparing (see Nipples, pecs, bras, OH MY!). Some of the things we talked about:

  • QuestionsHow much breast tissue (if any) will be left behind? A small disk of breast tissue remains under the nipple to prevent inversion.
  • What are the chances of breast cancer diagnosis? In the case of a prophylactic mastectomy (especially for a BRCA1/2-mutation-negative patient), the risk of developing breast cancer is still very low (<1%; see this summary table from the related article mentioned below). A long-term Georgetown study (related article #2 below) concludes that nipple-sparing mastectomy can be safe in properly selected patients.
  • What type of screening is done long-term? Screening is still required after any type of mastectomy via self and clinical exams. Mammography/ultrasounds/MRIs are generally not needed. However, screening MRIs are required when breast implants are used for reconstruction.
  • What are the chances of necrosis? From the nipple-sparing mastectomies my breast surgeon has performed, no nipples have been lost. He will make the incision laterally from the edge of the areola, versus circumareolar (tracing around it and then out). This will make the procedure technically a bit more difficult, due to a smaller access hole to the cavity, but will reduce the risk of necrosis. The article mentioned below also provides some data related to necrosis of the nipple-areola complex. 2/9: The incision that was actually made was a curved/smiley-face line about two inches below my nipple.
  • Will I have any feeling left? This is unlikely. Nipple(s) can become erect after this type of procedure, but the experience will not be the same as pre-mastectomy, both in cause and sensation.
  • Nipple Game Pad T-ShirtSo will I have permanent headlights? This is a possibility. A few of the ladies I’ve spoken to have expressed that this is true for them after a nipple-sparing procedure. As you can imagine, having constantly-erect nipples can make things awkward, so definitely something I hope I don’t have to deal with. However, in discussing with my PS, I learned that as with other possible unsatisfactory results, it can be addressed in a few different ways. Worst case scenario: another procedure to remove the nipples and areolae.

I’m confident that Dr. K is technically capable of performing this type of procedure and will do a great job. I am aware of the potential complications (not all listed here) – we’ll cross that bridge if we get to it.

Whew, that was the last thing to mull over, last detail to plan, last thing on my list that’s up to me (well, this list). Now the breast surgeon’s office confirms the insurance pre-authorization and I sign the consent forms. One pre-op appointment left with my plastic surgeon.

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3 thoughts on “Let’s give them a chance

  1. Pingback: Nipples, pecs, bras, OH MY! | Saying NOPE to Breast Cancer

  2. Pingback: Tissue necrosis | Saying NOPE to Breast Cancer

  3. Leaia

    I am still trying to figure out why one of my nipples died during a nipple sparing mastectomy and I was never told about it or was my family after surgery. The night after surgery I saw it was black. I asked my doctor about it and he said he didn’t know…well he knew but it really looked like it had been cut off at the end. He obviously knew or he wouldn’t have put something on it. Later it did bleed and I do have small breast but if the blood flow is lost how was it bleeding? There were so many surprises here but I am just trying to figure out what happened to it. I had this surgery after having atypical hyperplasia for the second time with a strong history of breast cancer in my family. Any ideas would be helpful on how this happened and the doctor doesn’t know. Thank you.


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