Nipple Sparing Mastectomy Saves Lives and External Breast

Oct. 27, 2011— -- Thirty-three-year-old Laura Scott sat in her doctor's office in shock.

Her physicians had just diagnosed her with stage 1 invasive breast cancer, after weeks of telling the young mom that they didn't believe the lump she'd found during a breast self-exam was cancerous. It didn't feel like cancer, they said. She did not have a family history of the disease or a genetic mutation. And she was young.

But they were wrong, and Scott was left to weigh her treatment options. She could choose a lumpectomy, but she wasn't willing to take the 8 to 12 percent chance of cancer recurrence. With two young daughters and a husband at home, she "planned on being around for a while."

Instead, she chose a bilateral mastectomy. And because the lump in her breast was not near her nipple, she could choose a procedure called nipple sparing mastectomy, or NSM.

"It became very clear early on that I wanted to go the most aggressive route," said Scott. "Still, It was incredibly scary to think of losing my breasts. As a woman, they certainly don't define you, but they are a part of you. Not to have them at my age was just unthinkable."

But she went ahead with the bilateral NSM, which entails the removal of the breast tissue, while keeping most of the breast's exterior, including the breast skin and nipple areola complex, intact. She also opted for immediate breast reconstruction.

"I woke up and I didn't even want to look," said Scott, who lives in Arlington, Va. "But when I did, I couldn't believe it. I looked normal, and that's all I could have asked for."

Now a new study published in the journal Plastic and Reconstructive Surgery found that some women who need a lumpectomy or mastectomy have another safe option with NSM, which doctors said offered women breasts with a more natural look and feel when compared to other forms of mastectomy.

"Nipple sparing mastectomy as compared to other forms of mastectomy is becoming more common, and the surgery is usually successful in terms of achieving good breast reconstruction with a low risk of complications," said Dr. Scott Spear, chairman of the department of plastic surgery at Georgetown University Hospital and co-author of the study. "There's a low risk of finding breast cancer or disease beneath the nipple in those patients who are offered nipple sparing mastectomy."

One of the main concerns with keeping the skin and nipple intact is the potential for cancer recurrence in the future. With that in mind, researchers reviewed the 169 NSM surgeries performed over 20 years at Georgetown University Hospital. They found there were no cancer recurrences and no new cancers on average for two and a half years after women underwent the procedure.

"There have been psychological studies to assess how women feel after having nipple sparing surgery compared to when the nipples have been removed," said Spear. "There is a dramatic difference shown that women are psychologically better off, in terms of self-esteem and sense of self, than those who have had the nipple removed. One of the appeals to this surgery is that you don't have to remove the breast skin and the nipple so it's similar to breast conservation."

But not every woman who needs a mastectomy is eligible for NSM. The procedure is dependent on several factors, including the size of the cancer, the size of the breast and the location of the cancer within the breast.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, agreed that the procedure is a good one for some patients who qualify, but he also expressed worry over the seemingly growing trend for women undergoing extreme surgeries, such as mastectomies, when they may have lesser invasive surgical options for their breast cancer treattment.

"It appears that some of these women who could have less aggressive surgery are opting for mastectomies for their own reason," said Lichtenfeld, who began treating women with breast cancer in the 1970s. "The risk is that people who influence other people, celebrities or other people in the media, may make a pronouncement that might lead other women to get a mastectomy when they don't really need it."

His expressed concerns come on the heels of Wanda Sykes' announcement last month that she underwent a double mastectomy after doctors diagnosed her with DCIS in her left breast. The non-invasive breast cancer is usually treated with a lumpectomy and has an excellent prognosis when found early.

"I was very, very lucky because DCIS is basically stage-zero cancer," Sykes said on the "Ellen DeGeneres show in September. "So I was very lucky."

"There is some evidence that excellent reconstruction options is one reason more and more women are choosing bilateral mastectomy," said Dr. David Euhus, professor of surgical oncology at University of Texas Southwestern Medical Center. "The nipple-preserving approach, with the incisions hidden beneath the breast and a well-proportioned reconstruction, makes mastectomy even more acceptable to more women."

Nevertheless, experts said, if women do opt for NSM, it's important to have a surgeon who is well-versed in the surgery and has performed it many times, as risks include infection, not adequately taking out the cancerous tissue and potential nipple loss because the blood supply could get cut off.

Lichtenfeld noted that, after being informed of her options, every woman must make her own personal decision for breast cancer treatment. Still, he expressed concern that some women may not know all their options, and they may be impacted other women's decision to go a more aggressive route than necessary.

"What really scares me is that I went through the era where women were disfigured after mastectomies," said Licthenfeld. "Women were not as willing to come to the doctor if they felt a lump out of fear of disfigurement. I begin to wonder whether the prevalence and pronouncement of getting mastectomies will set us back, and women will be afraid that, if they feel a lump, they only have the option of mastectomy."

Nevertheless, "if woman makes an informed decision, then whatever she decides for a treatment option is acceptable," he said.