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Preserving Nipple Sensation After Breast Cancer Surgery

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Advances in breast cancer treatment have improved survival rates and quality of life for many women. One example is nipple-sparing mastectomy (NSM), a procedure that removes the cancerous tissue while preserving the nipple, areola and most of the healthy breast tissue.

Unfortunately, most women who get the procedure lose sensation in the nipple. A new collaboration between a surgical oncologist and a plastic surgeon is changing that.

“We’re very excited to offer this surgery to breast cancer patients,” says Joseph Khouri, MD, a plastic surgeon who collaborates with Ashley Simpson, DO, a surgical oncologist, at University Hospitals Seidman Cancer Center.

Who Is a Candidate?

A nipple-sparing mastectomy is typically only offered to early-stage breast cancer patients with tumors smaller than 3 centimeters and at least 2 centimeters away from the nipple.

Using the nerve sparing technique and an understanding of surgical blood supply, Dr. Simpson and Dr. Khouri are able to perform the procedure on patients who would not normally be candidates.

How the Procedure Is Performed

During the surgery, Dr. Simpson removes all or most of the breast tissue while preserving the nipples, areola and most of the skin. She carefully identifies and protects the nerves that provide sensation to the nipples.

Next, Dr. Khouri performs breast reconstruction surgery using tissue from the patient’s body or synthetic implants. He performs microsurgery to reconnect the nerves that bring sensation to the nipple and areola.

“What makes our collaboration unique and sets us apart from most other hospitals in the country, is our ability to offer NSM with extended eligibility criteria, with immediate breast reconstruction and nipple sensation preservation,” says Dr. Simpson.

In most cases, Dr. Khouri will perform the breast reconstruction immediately following mastectomy as part of the same operation. The procedure does not require the use of tissue expanders and often eliminates the need for additional surgeries.

Nipple Sensation Preservation

During the breast reconstruction procedure, Dr. Khouri performs a nerve graft using healthy nerve tissue to repair disconnected nerves that bring sensation to the nipple. In traditional mastectomy, these nerves are not saved or reattached.

“The amount of sensation that can be preserved by the surgery varies from patient to patient,” says Dr. Khouri. “Once the nerve graft is in place, it regenerates approximately one inch per month. This means it may take three to seven months to see how much sensation returns.”

Is It Safe?

Candidates for the surgery may have safety concerns, wondering if there’s a possibility that the preserved nipple tissue could contain cancer cells.

“Prior to getting approved for surgery, every patient receives a nipple core biopsy,” says Dr. Simpson. “As long as no cancer cells are detected in the tissue sample, this procedure is just as safe as a routine mastectomy and breast reconstruction.”

A New Standard of Care

While NSM with nipple sensation preservation is becoming more common, it’s still not the standard of care.

“The biggest hurdle we face right now in bringing this procedure to more women is that most insurers still consider it experimental,” says Dr. Khouri. “As a result, they won’t pay for the nerve grafts yet.”

Dr. Khouri and Dr. Simpson are optimistic that NSM with nipple sensation preservation will eventually become the standard of care, with insurance companies adapting accordingly. In the meantime, they are committed to raising awareness of this surgery and the benefits for women confronting a breast cancer diagnosis.

“We like to think outside the box,” says Dr. Simpson. “We’re always on the lookout for what we can do to improve breast cancer surgical options that extend and better the lives of our patients.”

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University Hospitals Seidman Cancer Center, our care team offers the most advanced forms of cancer care, including prevention, screening, diagnosis, treatment and cancer survival support. Our disease-focused teams design personalized cancer treatment plans for every patient who entrusts their care to us.

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