Nipple Delay Surgical Procedure

Increasing Success For Your Nipple Sparing 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. A patient would probably call this surgery "mastectomy delay" instead, because it pushes back the date of your mastectomy by one to two weeks. Nipple delay is 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. A biopsy of tissue from beneath the nipple will reveal whether or not your nipple may be spared.

Keeping Your Natural Nipples After Mastectomy

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 the necrotic tissue will have to be surgically removed. The surgical procedure called "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.

A Nipple-Sparing Mastectomy Isn’t For Everybody

Women with BRCA genetic mutations who choose prophylactic mastectomies may be able to keep their natural nipples. Other good candidates include patients with a tumor located away from the nipple, or who have no breast skin affected by the cancer. No cancer must be found in the subareolar biopsy taken before the nipple- and skin-sparing mastectomy, and there must also be no bloody nipple discharge. You must not be an active smoker, as this restricts blood flow and compromises the health and healing process.

Risks of Nipple Sparing Mastectomy

In addition to the standard risks of surgery — anesthesia, pain, bleeding and infection — there is a very low risk that the nipple may not survive 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 done on 99 women who were followed for five years. They report that 22 of the spared nipples were eventually lost to cancer, 8 failed, and 2 were electively removed. The study states, “There was no nipple necrosis when NSM (nipple-sparing mastectomy) was performed after a surgical delay procedure.” However, if a subareolar biopsy reveals cancer before a nipple-sparing mastectomy, it must be removed. Even one cancer cell is too many to keep.

Benefits of Nipple Sparing

Keeping your natural nipples preserves the original look and feel of your breasts, without needing nipple reconstruction. Some of the tactile sensation of natural nipples will persist if a good sample of nerves stay connected, but a reconstructed nipple will not have any sensitivity other than pressure.

Nipple Delay Surgical Procedure

Nipple Delay Mastectomy Incisions
Nipple Delay: Options for Mastectomy Incisions. Nipple Delay Options for Mastectomy Incisions, Art © Pam Stephan

A nipple delay procedure is scheduled as outpatient surgery about two weeks before your mastectomy. You will be under anesthesia and won't feel any pain during the surgery. Your surgeon will make an incision in your skin at the point 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, and encourages new vessels to connect from breast skin to your nipple-areola complex, keeping it alive. Your surgeon will also take a biopsy of tissue from under your NAC and send it to the pathology lab. Women who have existing scar tissue near the nipple and areola would benefit from a nipple delay procedure.

Healing and Aftercare

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 green, as these work best when taken preventatively. Take it easy until you feel your energy levels return to normal.

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Article Sources
  • Nipple-Sparing Mastectomy in 99 Patients With a Mean Follow-up of 5 Years. J. Arthur Jensen MD, Jay S. Orringer MD, Armando E. Giuliano MD. Annals of Surgical Oncology. June 2011, Volume 18, Issue 6, pp 1665-1670.
  • Jensen, J. A.; Lin, J. H.; Kapoor, N.; Giuliano, A. E. (2012). "Surgical Delay of the Nipple-Areolar Complex: A Powerful Technique to Maximize Nipple Viability Following Nipple-Sparing Mastectomy". Annals of Surgical Oncology 19 (10): 3171-3176.