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If a mastectomy is part of your breast cancer treatment plan, your surgical team may have mentioned nipple-sparing mastectomy (NSM) as an option. It’s one of several mastectomy types, and it may allow you to preserve some natural breast tissue.
Here’s what a nipple-sparing mastectomy involves, its potential benefits and risks, and what recovery looks like.
A nipple-sparing mastectomy is one type of skin-sparing mastectomy. These breast cancer surgeries preserve some of the healthy skin on the breast to maintain a more natural appearance.
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A standard skin-sparing mastectomy removes breast tissue along with the nipple and areola, while keeping as much healthy breast skin as possible to create a natural shape during reconstruction. A nipple-sparing mastectomy goes a step further and preserves the nipple and areola, too.
NSM used to be known as a subcutaneous mastectomy. In the 1970s, surgeons sometimes left breast tissue behind on purpose as a way to protect the nipple and improve cosmetic outcomes. However, in some cases, cancer appeared in that leftover tissue.
Because of this risk, today’s NSM completely removes all breast tissue, leaving only a thin layer of fat to keep blood flowing to the skin. Surgeons typically make incisions in the fold beneath the breast or beside the breast. The overall risk of the cancer coming back after an NSM is about the same as with other mastectomy types.
Some doctors may recommend an endoscopic version of the surgery. This involves a much smaller incision and a camera-guided instrument. Endoscopic NSM is designed to remove breast tissue with minimal scarring and faster recovery, maintaining the nipple, skin, and areola.
Your surgeon may perform immediate breast reconstruction during the same procedure as the nipple-sparing mastectomy. In other cases, the surgeon may place a tissue expander immediately after the mastectomy and perform reconstruction later. The expander helps your skin prepare for the breast implant later on.
Talk to your doctor about whether you’re a candidate for immediate reconstruction or whether they prefer to delay that procedure.
Not everyone with breast cancer is eligible for NSM. Your breast tumor must be a safe distance from the nipple and areola for this surgery to be successful. Doctors usually prefer the tumor to be more than 2 centimeters away from the nipple-areola complex.
Your general health matters, too. Lifestyle factors like heavy smoking, uncontrolled diabetes, or a blood clot disorder can negatively impact recovery and might make NSM a less suitable option.
For people with larger breasts, doctors may suggest a preliminary breast reduction surgery before NSM. Larger breasts tend to have less successful results with NSM — necrosis (tissue death) of the nipple and poor cosmetic outcomes may occur. So, reducing breast size in advance can improve the odds of a good outcome.
It’s important to discuss the possible risks and benefits of NSM with your plastic surgeon before undergoing the procedure.
Many people find that NSM produces a result that looks more like your natural breast, often with less visible scarring. One study of people who’d had a nipple-sparing mastectomy found that about 73 percent said they’d choose the surgery again.
This sentiment is echoed by several MyBCTeam members. “I woke up from the bilateral mastectomy with my own nipples, and expanders filled with more saline than my original breasts,” one member said. “It helped me deal with the loss of my breasts. I felt ‘normal’ in an abnormal situation. … Seventeen months later, I have no regrets.”
Another member said, “I am very glad I did the nipple-sparing surgery. It made the reconstruction process much simpler than it would have otherwise been, and I’m very happy with the aesthetic result.”
One potential side effect of NSM is reduced sensation in the nipple. But that feeling may return to your nipple eventually.
“I had a nipple-sparing mastectomy,” one MyBCTeam member said. “My breasts look the same as before, just no feeling.”
Another member replied, “I was told I would not have nipple sensation, but I do. Standing outside one evening maybe three weeks after surgery, wind blew my T-shirt against my nipple and BAM, there it was!”
Another risk of NSM involves eventually losing the nipple due to necrosis stemming from poor blood flow. In one study, about 23 percent of people had some necrosis after NSM. Of those, 6.7 percent ended up losing their nipple completely. Your personal risk depends on a range of factors, including breast size, incision choice, and surgical technique.
NSM Recovery Recovery from NSM follows a similar timeline as other mastectomies. Many people stay one or two days at the hospital during mastectomy recovery. But some people may go home the same day as the surgery.
“I had my bilateral nipple-sparing mastectomy yesterday, and I must say I’m doing pretty well today!” one member said. “I was so scared of the ‘what if’ before surgery, but now I’m looking forward to my journey of recovery!”
Before leaving the hospital, your care team will explain how to care for the incision and surgical drains at home. Surgical drains typically stay in place for about two weeks, and bruising and swelling should subside within a week.
Most people are able to return to their normal activities within one or two months. Your doctor may recommend arm exercises to prevent shoulder stiffness.
“I had bilateral nipple-sparing surgery with immediate permanent silicone implant reconstruction,” one MyBCTeam member said. “I went back to work four weeks post-op.”
Another member said, “Mine was a nipple-sparing bilateral mastectomy with expanders. I went back to work after three weeks, but I think that was too soon.”
You and your doctor should discuss your recovery plan. They can also advise you on a realistic timeline for when you can go back to work after your mastectomy.
Keep your doctor updated on any noticeable changes around your incision. Heat, swelling, discoloration, or consistent pain are all symptoms that you should report to your doctor right away.
A breast cancer diagnosis requires you to make a lot of decisions at once, and nipple-sparing mastectomy is only one piece of your overall treatment plan. Your timeline and method for reconstruction are decisions best made with your care team. Open discussion around your concerns and goals for recovery will help you and your healthcare provider choose the best possible plan for you.
On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.
Did you have a nipple-sparing mastectomy? What were your results like? Let others know in the comments below.
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