Nipple-sparing mastectomy keeps the nipple and areola as well. Distance decides. Before surgery, MRI checks that the cancer lies well away from the nipple, and during surgery the pathologist examines a slice of the tissue directly behind it while you remain asleep, so that a nipple holding cancer cells comes off in the same operation instead of a second one weeks later.
Risks, results and recovery
Five risks matter most.
- Skin flap necrosis, where part of the thin skin loses its blood supply.
- Bleeding.
- Infection, which with an implant in place sometimes means taking the implant out for several months until the tissue settles and a new one goes in.
- Numbness.
- Cancer returning in the skin or chest wall.
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Skin-sparing against conventional mastectomy, pooled studies
| Outcome |
Skin-sparing |
Conventional |
| Local recurrence |
6.2 percent |
4.0 percent, no significant difference |
| Distant relapse |
10.0 percent |
12.7 percent |
| Women studied |
1,104 |
2,635 |
In carefully selected cases, NSM is a viable choice for women with breast cancer who need to have a mastectomy.
Systematic review of 14 studies, BJS Open, 2019
Skin flap necrosis
How often it happens
Thin skin lives on thin vessels. Cut too thin or stretched too far over an implant, part of the skin darkens over the first days, and a full-thickness area dies and needs trimming.
Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%-30% in the literature.
Review of skin flap necrosis, 2017
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What raises the risk of skin flap necrosis, and what we do
| Risk factor |
What we do |
| Smoking |
Stop at least four weeks before and after surgery |
| Diabetes |
Control blood sugar before surgery |
| Obesity and large breasts |
Consider a staged or reduction-pattern approach |
| Earlier radiotherapy or scars |
Plan the incision around them, often with the patient's own tissue |
| Other serious illness |
Medical review before surgery |
If skin necrosis happens
Small areas of darkened skin heal with dressings over a few weeks. Larger, full-thickness areas are trimmed early, sometimes with removal of the expander or implant, to avoid infection and delay to chemotherapy or radiotherapy.
Lowering the risk
Careful planning of the incision, a flap of even thickness, and checking the blood supply of the skin at the end of the operation all lower the risk, and a smoker who stops before surgery helps most of all.
Nipple-sparing against skin-sparing
The numbers side by side
Same cancer control. More complications, nearly all from the nipple.
Breast-conserving surgery against mastectomy over twenty years
Twenty years of follow-up in the American trial gave the same survival in all three groups.
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NSABP B-06, twenty years, 1,851 women
| Treatment |
Overall survival |
Cancer back in the treated breast |
| Total mastectomy |
No difference |
Not applicable |
| Lumpectomy with radiotherapy |
No difference |
14.3 percent |
| Lumpectomy alone |
No difference |
39.2 percent |
Recovery and the stay in Istanbul
Two to four nights in hospital, drains out at one to two weeks, and the final pathology report within ten days, which decides on chemotherapy, hormone therapy or radiotherapy. Plan two weeks in Istanbul, longer with a flap reconstruction, and our surgeon confirms fitness to fly before you leave. A companion can sleep in your room, our coordinators speak English, Arabic, French, Russian, Serbian, Romanian and Spanish, and follow-up after you return home runs through them, with our tumor board sending a written treatment plan to your oncologist. The cost depends on one or both sides and the type of reconstruction, and the estimate after the free review lists each.
1
Week one
Walking from the first day, gentle arm movement, drains managed by our nurses.
2
Week two
Drains out, the wound checked, the pathology results discussed with you.
3
Weeks three to six
Arm and shoulder exercises, driving once the drains are out and you can turn the wheel quickly without pain, and a return to desk work for most women by the end of this period.
4
After six weeks
Lifting and exercise.
Skin-sparing mastectomy FAQ
Is skin-sparing mastectomy as safe as a regular mastectomy?
In pooled studies of 3,739 women, local recurrence did not differ significantly. The skin left behind contains no breast tissue.
Can I keep my nipple?
If MRI and the tissue behind the nipple show no cancer there, nipple-sparing surgery is an option. It carries a 15 percent risk of nipple necrosis.
Will I need radiotherapy after mastectomy?
Sometimes, depending on the size of the tumor and the lymph nodes. The pathology report decides, and radiotherapy affects the reconstruction.
Is reconstruction done in the same operation?
Yes, in most cases. Our page on breast reconstruction after mastectomy explains the options.
Will the reconstructed breast have feeling?
The skin stays numb for most women, with partial return over months to years.
References
- Lanitis S, Tekkis PP, Sgourakis G, et al. Comparison of skin-sparing mastectomy versus non-skin-sparing mastectomy for breast cancer: a meta-analysis of observational studies. Annals of Surgery. 2010;251(4):632-639.
- Agha RA, Al Omran Y, Wellstead G, et al. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy. BJS Open. 2019;3(2):135-145.
- Robertson SA, Jeevaratnam JA, Agrawal A, Cutress RI. Mastectomy skin flap necrosis: challenges and solutions. Breast Cancer: Targets and Therapy. 2017;9:141-152.
- Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine. 2002;347(16):1233-1241.
- Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New England Journal of Medicine. 1999;340(2):77-84.
