From Nipple Sparing Mastectomy to DIEP flap Breast Reconstruction
A nipple sparing mastectomy to DIEP flap breast reconstruction can be a very successful surgical process after being diagnosed with breast cancer. I want to share my success story and reference articles that I have been reading about nipple sparing mastectomy (NSM).
My NSM Experience: Breast Surgeon
I credit my breast surgeon, Dr. Michele Boyce Ley, and my plastic surgeon, Dr. Minas Chrysopoulo, for the success of my nipple sparing mastectomy and DIEP flap breast reconstruction. My NSM process began in my breast surgeon’s office the day we consulted about next steps after my second breast cancer diagnosis. She was very hopeful but realistic about saving my nipples while performing my double mastectomy knowing I had in mind that I wanted DIEP flap later.
The MRI scan ordered prior to my mastectomy led her to make this pre-surgical assessment due to the tumor size and location from the nipple as well as techniques she was trained in and successfully performed. I am also a non-smoker. Smoking has the very high potential of inhibiting wound healing. I was and continue to be in good health with no other comorbidities such as diabetes that can compromise the success of NSM. These are some of the important factors that are used to assess the likely success of NSM in patients.
Maintaining adequate skin thickness and the blood supply are factors in the success of NSM during the time of the mastectomy. My breast surgeon explained that she would utilize these techniques but at the same time was realistic about the possibility of necrosis of the nipple areola complex (NAC) during the time of my mastectomy. She successfully performed the procedure and I began researching a highly-qualified microsurgeon to perform my DIEP flap while recovering from my NSM.
My NSM Experience: Plastic Reconstructive Surgeon
My plastic surgeon, Dr. Chrysopoulo, evaluated my case five months after my double mastectomy. He carefully examined the results of my NSM and explained to me where he would insert the flap of skin for my delayed DIEP flap breast reconstruction. Two months later, seven months after my NSM, my DIEP flap surgery was performed. The morning of my surgery, he carefully marked the area and described where the flap would be just under the nipple line. He also explained that he would be removing scar tissue in the left breast that was present from radiation twelve years previous from my first breast cancer diagnosis.
Dr. C, as his patients frequently call him, utilized his intricate microsurgical skills to maintain and save the nipple areola complex (NAC) during my DIEP flap breast reconstruction. Additionally, he used the SPY Elite Fluorescence Imaging System that I wrote about in a blog here. This tool monitors blood perfusion of the new breast including that of the NAC during surgery and for a short period of time after DIEP flap.
The results and aesthetic outcomes were highly successful and truly beyond my expectations. The combined efforts of these two surgeons in their respective fields led to a highly successful experience for me. Although my situation was seemingly challenging in that the surgeries took place in two different states, the key to the success was the quality of information and shared decision-making process I was a part of with both surgeons.
Recent Studies in Nipple Sparing Mastectomy
There have been recent studies that more women are opting for NSM. My hope is this would also be the case for my male counter parts who also undergo mastectomy due to breast cancer. One of the encouraging statements from the Healthline article stated:
There were no reports of any recurrences involving the nipple. It’s unusual for breast cancer to start in the nipple, even among women who are at high risk.
This doesn’t mean that it cannot happen but it is unusual. The study also mentioned that NSM is an option for some but not all. This must be carefully evaluated by the surgeon performing the mastectomy. A microsurgeon who routinely and successfully performs DIEP flap breast reconstruction and one that I have high regard for, Dr. Daniel Liu, states in the article:
Patients with unrealistic expectations, patients who are struggling emotionally, active smokers, patients with very large breast, patients with certain medical comorbidities, or patients who expect full nipple sensation to return may not be good candidates for a nipple-sparing mastectomy.
The options are to live without nipples or to have them rebuilt with added areola tattooing. I have seen first-hand results of both implant and DIEP flap patients who for various reasons did not have NSM. Those who chose not to have nipples rebuilt during reconstruction have had the feminine form restored before mastectomy and it yields aesthetically pleasing results in their clothing, with or without their nipples.
I have also seen first hand results of women who have had nipple reconstruction during a second phase of DIEP flap breast reconstruction. Many return for a third procedure that involves the tattooing of the areola complex. There are tattoo artists, Vinnie Meyers, and Amy Black to name two, who are doing amazing 3-D tattoos of the areola. Again, I have seen these results first-hand and the artistry and skill is truly to be admired.
Nipples are an important part of the anatomy of the breast. I was pleased to read the articles about the success of NSM and hope my own experience enlightens readers about the questions to ask during your consult as well as the process of the surgery. I am also reassured to know that many women who have had breast reconstruction live successfully without nipples. Additionally, it is valuable to know that the choice to rebuild the nipple can be successfully done during breast reconstruction with the added component of the areola tattooing.
What was your breast reconstruction experience that included either NSM, choosing not to reconstruct your nipples, or choosing to reconstruct the nipple with tattooing of the areola?