Follow up: Am I a good candidate for a Nipple Sparing Mastectomy, since I have sagging breasts? (photos)

I was diagnosed with invasive ductile cancer, and am scheduled for bilateral mastectomies, with tissue expander, followed by silicone implants. Tumor is 4 cm. I am concerned about amount of sagging following surgery, since my breasts sag already. I do not want large breasts, 32 B would be ideal after reconstruction. I am more concerned with shape, and "perkiness" than I am size. I am worried that I will be left with severe sagging and deflated breasts until reconstruction is done in 6mths.

Doctor Answers 5

Nipple sparing mastectomy with ptosis (sagging)

I have had successful nipple sparing mastectomy surgery and one stage reconstruction with our team of plastic surgery colleagues with patients similar to you. Yes - I do think it could be attempted, depending on what your goals for size and appearance would be.

Nipple Sparing Mastectomy

Thank you for your question. NSM have become a common therapy for breast cancer as our awareness of breast cancer behavior has improved. That being said, I always tell my patients that there are three reasons to save the nipple: 1. there is no current cancer present in the nipple, 2. the likelihood of future cancer in the nipple is low, 3. the nipples are in the correct location to undergo a nipple sparing mastectomy and have an appropriate aesthetic outcome. The first two questions should be answered by your breast oncologic surgeon. As for the third question, it is important to have an open dialogue with your plastic surgeon as to what has been the best aesthetic outcome in his/her practice. Preserving the nipple in mastectomies can cause significant challenges for plastic surgeons as the location of the nipple, symmetry and viability can vary significantly. Measures taken to ensure appropriate positioning must occur to avoid future complications which sometimes can be irreparable. Based on your pictures on the thread, you would be a good candidate for NSM from an aesthetic standpoint. However, know that your particular situation is complex given you have asymmetry of your inframammary folds, discrepancies between the breast and skin envelope which can cause some post reconstructive deformity. 

Rahim Nazerali, MD
Palo Alto Plastic Surgeon

Still not easy to tell

Without some basic measurements, it's hard to tell.  I'd love to tell you that unequivocably you are a great candidate for NSM.  It appears you have some discrepancy in your fold position and the measurements from your sternal notch to nipple and nipple to fold on stretch would help.  I think you could likely have a NSM- I just worry if you won't get a better result with a vertical mastectomy pattern followed up with 3-dimensional nipple areolar tattooing.  Hope this helps.

-JGH

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Sagging breasts and nipple sparing

With sagging breasts such as yours,  it can be difficult to get a good shape after a nipple sparing mastectomy.

Steven Wallach, MD
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Dr Kayser

Thank you for your question and the photos from your follow up yesterday. You do have some drooping, but this does not mean you could not java a nipple sparing mastectomy. Again, this would be more determined by your general surgeon who would make a decision about the risks of the tumor and keeping the nipple. Realize, however, that even if the nipple were taken, the areola pigmented tissue surrounding it could still be spared. You could also have a breast lift which could occur either before or after the procedure. These are all questions that I would ask your plastic surgeon. I would anticipate that you very well could end up with a very nice result especially with the addition of fat transfer along with tissue expansion. I hope this helps and have a wonderful day. Dr Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.