Areola Reduction & mastectomy - which approach is safer for nipple survival?

Question

Unfortunately I was diagnosed with breast cancer, left breast. I am scheduled for a mastectomy on that side. I want an areola reduction on the healthy right breast. I have two options: 1) Have a bilateral mastectomy and come back 3-6 months later for areola reduction or 2) have unilateral mastectomy on left side and have areola work done on right side during the mastectomy surgery....I am wondering which approach is safer for nipple survival or if there are equivalent risks?

Joshua Jacobson, MD - Account Suspended · Answer

Hi. If you undergo areola reduction first and then undergo mastectomy a few months later, the nipple will have a better chance of survival. Generally speaking, mastectomy cuts majority of the blood supply to the nipple and keeps only a small fraction of the original blood supply. However, when you perform areola reduction, you cut some of the the blood supply to the nipple but you maintain a large portion of it. As healing takes place, the remaining blood vessels get augmented because there is more demand on them. This is called the "Delay Phenomenon." Subsequently, when you undergo mastectomy, another portion of the blood supply is cut off but the remaining blood vessels have been augmented and therefore the nipple has a better chance of survival.

Areola Reduction & mastectomy - which approach is safer for nipple survival?

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