Nipple delay procedure 2-3 weeks prior to bilateral proph. mastectomy. Who does this procedure? I was given 2 different answers

I went for 2 opinions for risk reducing mastectomies, NIPPLE SPARING for brca mutation. At one facility the plastic surgeon does the nipple delay procedure to increase the chance of the nipple surviving. At a 2nd facility the breast surgeon said he does the nipple delay procedure. I have no idea who would be best at doing this., breast surgeon, or plastic surgeon?

Doctor Answers 3

Nipple delay

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Some surgeons feel the blood supply to the nipple is strengthened if some of the tissue under the nipple is removed a few days/weeks before the actual Mastectomy. This is somewhat controversial as even when a nipple delay is performed, some surgeons still see their patients' nipples have poor blood supply. At our center, we do not use nipple delay technique. We perform a nipple sparing mastectomy through an incision on the bra line 95% of he time- and usually a direct to implant reconstruction in the same setting, with the help of our plastic surgery colleagues. Our nipple necrosis (dead nipple) rate is less than 1%. I consider the nipple delay to be an unnecessary extra step and unless a patient had severe concern for poor blood supply, I wouldn't bother with it. 

Beverly Hills General Surgeon
5.0 out of 5 stars 2 reviews

Nipple "delay" prior to prophylactic mastectomy

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Nipple sparing mastectomy for BRCA mutation is becoming increasingly in demand as women learn more about breast cancer prevention and treatment.   Delay procedures are a tried-and-true method to minimize soft tissue loss during elective and reconstructive procedures.  Either a breast surgeon or a plastic surgeon can perform the delay procedure.   Would recommend having your plastic surgeon and breast surgeon discuss scar placement so that you will have the best overall aesthetic result.   Best to you.  

Joseph Franklin, MD
Durham Plastic Surgeon
5.0 out of 5 stars 8 reviews

Nipple sparing mastectomy

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Nipple sparing mastectomy is now being performed more often, but only minority of breast cancer patients are a candidate, depending on size, type and location of the cancer. Not every patient needs a delay procedure, but a delay procedure can improve the nipple survival if your reconstructive surgeon believes you may be at risk for nipple necrosis. I believe both surgeons are qualified to perform the procedure, but I would think that the surgeon performing the reconstruction would want to be involved since he or she will be working with the nipple aerolar complex during the reconstruction phase.

Shahriar Mabourakh, MD, FACS
Sacramento Plastic Surgeon
4.9 out of 5 stars 228 reviews

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