How is it determined if my nipple can be saved at the time of mastectomy?

This text originally appeared as part of Learn Look Locate’s monthly series, “Ask a Plastic Surgeon with Dr. Israeli.” Visit learnlooklocate.com to learn more about their mission.

With nipple-sparing mastectomy breast tissue is removed while the breast skin and nipple areola are preserved. Many women are good candidates for nipple-sparing mastectomy, particularly those facing risk-reducing surgery. ⁠
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For any woman facing mastectomy, shared decision-making with the breast surgeon and the plastic surgeon is critical in guiding the decision to proceed with nipple-sparing surgery. If you are interested in nipple-sparing mastectomy, ask your breast surgeon and plastic surgeon if you are a candidate for this type of procedure.⁠
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Breast surgeons follow specific criteria when recommending nipple-sparing mastectomy. Important factors for breast surgeons include size of the breast cancer and proximity of the tumor to the nipple areola. ⁠
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If proceeding with nipple-sparing mastectomy is deemed to be safe from a cancer perspective, it is then important to determine if it is also safe from the plastic surgeon’s point of view. ⁠
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Criteria that plastic surgeons take into account include breast size, nipple areola position, and the type of reconstruction planned. From a plastic surgery perspective, it is more challenging to preserve the nipple at the time of mastectomy in women with larger breasts, and women with breasts that are lower on their chest. In these situations, preserving the nipple may require a staged approach, beginning with a breast lift or breast reduction before proceeding with mastectomy and reconstruction.⁠
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Compared to more traditional mastectomy techniques, nipple-sparing mastectomy is a technically more challenging procedure. Make sure that your surgeons are experienced with nipple-sparing mastectomy and breast reconstruction before proceeding⁠