It is usually possible for a woman to keep the breast skin, and often the nipple and areola, after a mastectomy.
Nipple-sparing mastectomy is a procedure that preserves the breast skin, nipple, and areola after a mastectomy. Skin-sparing mastectomy preserves the breast skin but not the nipple and areola. The nipple-sparing mastectomy in particular is considered the ideal scenario for breast reconstruction when it is possible.
The ability to have a nipple or skin-sparing mastectomy depends on the size and location of the cancerous tumor. If the tumor can be removed while preserving the skin, nipple, and areola, then those elements of the breast can be incorporated into breast reconstruction.
Nipple-sparing and skin-sparing mastectomies are only advantageous in the case of immediate or delayed immediate breast reconstruction. If a natural tissue procedure occurs at the same time as the mastectomy, or if a tissue expander or implant is placed at the same time as the mastectomy, the nipple, areola, and breast skin can be used.
If reconstruction will not occur until after the surgery, then the nipple, areola, and breast skin cannot be effectively preserved and utilized. In delayed reconstruction, skin from a natural tissue flap can be incorporated to build the new breast. Nipple and areola reconstruction with medical tattooing may also be done to complete the reconstruction.
If the cancer tumor is located near or close to the nipple, a nipple-sparing mastectomy may not be possible. Also, if the blood supply to the nipple is not adequate or the nipple is in a poor position for reconstruction, it may be better to remove and reconstruct the nipple and areola later.
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