What is the Nipple Delay Surgical Procedure for Breast Reconstruction?

Preserving the nipple for breast reconstruction after mastectomy

Female doctor talking to woman in exam room, smiling
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Nipple delay is a surgical procedure done in preparation for a nipple-sparing mastectomy. It's only one of many nipple-sparing surgical techniques—all of which are controversial, since many breast cancers may originate in the ducts of the nipple itself. To find out whether it's safe for you to keep your nipple, your doctor will perform a biopsy on tissue from beneath the nipple.

Purpose of Procedure

Your nipple and areola complex (NAC) needs a dedicated supply of blood in order to be healthy. If there is no dependable circulation to these tissues after a nipple-sparing mastectomy, those structures may die and have to be surgically removed. Nipple delay is intended to create new circulatory connections from the breast skin to the NAC that will keep your natural nipples and areolas alive and well.

Benefits of Nipple Sparing

Keeping your natural nipples preserves the original look and feel of your breasts without requiring nipple reconstruction. You may even keep some of the tactile sensations of natural nipples if a good sample of nerves stays connected. Meanwhile, a reconstructed nipple won't feel anything other than pressure.

Women with BRCA genetic mutations who choose prophylactic mastectomies are often considered good candidates for keeping their natural nipples.

Not every woman will need nipple sparing surgery in order to conserve her nipples. Ask your doctor what will give you the best chance of preserving yours and whether you're a good candidate for the procedures.

Risks and Contraindications

In addition to the standard risks of surgery—anesthesia, pain, bleeding, and infection—the primary risk of nipple delay is the low risk of the nipple not surviving despite the best attempts to keep it.

A study done at John Wayne Cancer Institute in Santa Monica, California, reported on results of nipple-sparing surgery performed on 99 women who were followed for five years. Researchers reported that 22 of the spared nipples were eventually lost to cancer; eight surgeries failed; and in two cases, women chose to later have their nipples removed.

Nipple delay isn't a good option for everyone. Those who are not considered good candidates include those with:

  • Tumors near the nipple
  • Cancerous findings in the subareolar biopsy
  • Skin that is affected by cancer
  • Bloody nipple discharge
  • Smokers (due to a restriction of blood flow that compromises the healing process)

Before the Procedure

The facility where your procedure is being done may want you to come in for a pre-operative appointment to fill out paperwork and ask any questions you may have. If not, you'll need to be sure you arrive early enough before your scheduled time to take care of these things.

Timing

A nipple delay procedure is scheduled as outpatient surgery about two weeks before your mastectomy.

Location

This procedure is performed at hospitals and surgical centers.

What to Wear

You'll be in a hospital gown for the procedure. However, for going home, you'll want to have a supportive, soft-cup bra and a button-down shirt, so you won't risk straining the recovering area by raising your arms above your head.

Food and Drink

You'll need to fast (not eat or drink anything) for eight to twelve hours before your surgery. Ask ahead of time whether you can take your daily medications the morning of the procedure. (Also make sure you know whether you'll need to be off of any medications or supplements for an extended period before surgery.)

Cost and Health Insurance

Be sure to check with your insurance company to see whether, and to what extent, your policy covers nipple delay, mastectomy, and breast reconstruction. In addition, ask about your surgeon, anesthesiologist, and the facility.

If you have a co-pay, check with the facility where the procedure is being done to see when that will be due.

What to Bring

Make sure you have your insurance card, identification, and any paperwork the doctor may have given you when you arrive for your procedure.

It's a good idea to have something to read or entertain yourself with. You may be there for a while before the surgery begins.

During the Procedure

Pre-Surgery

You'll have an intravenous (IV) tube placed in your hand to deliver fluids, anesthesia, and possibly medications. A nurse will check your vital signs and the anesthesiologist will likely talk to you about the anesthetic you'll receive and what to expect for it.

Your surgeon may also come in and review things with you. The breast to be operated on will be marked to make sure there's no error.

Throughout the Surgery

Once you're asleep, your surgeon will make an incision in your skin where your mastectomy scar will be located. This may be under your areola or in the crease beneath your breast.

About half of your breast skin will be lifted off of the fatty and glandular parts of your breast; this will disconnect the blood vessels that normally provide circulation to your nipple, which encourages new vessels to connect from the breast skin to your nipple-areola complex, thus keeping it alive.

Your surgeon will also take a biopsy of tissue from under your NAC and send it to the pathology lab.

Post-Surgery

Once you're stitched up and bandaged, you'll be moved to a recovery room to come out from under the anesthesia. Once you're awake, as long as everything is going as planned, you'll be given follow-up care instructions and discharged.

You'll need to have someone drive you home, as it's not considered safe to drive within 24 hours of being under general anesthesia.

After the Procedure

Ask your surgeon or the facility how long it will take to get your biopsy results back. These will tell you whether you can actually keep your nipple or if the nipple itself may be cancerous.

Managing Side Effects

You may have some discomfort and bruising during recovery from a nipple delay procedure. Some surgeons may have you use a skin cream on the breast before or after your surgery.

If you need anti-nausea medications, be sure to take those exactly as prescribed—don’t wait until you feel sick, as these work best when taken preventatively. Take it easy until you feel your energy levels return to normal.

If you experience any unexpected or severe side effects from the surgery, call your doctor.

A Word From Verywell

Talk to your doctor before the procedure about what the odds are that you'll be able to keep your natural nipples. While optimism is great, it also pays to be realistic so you're not emotionally devastated by a failure you didn't think was likely or even possible.

Regardless of what part of your breast(s) you keep or lose, this process is about safeguarding your health and defeating breast cancer. While you'll deal with many things along the way that can be physically and emotionally difficult, try to say focused on the goal, which is keeping you alive and returning you to good health.

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