Did my Wife Receive Nipple Saving Surgery or Not? (photo)

My wife had DIEP nipple saving surgery 7 weeks ago. She did not have cancer prior to surgery. We notice two weeks after the surgery that her nipples were cut right through. We asked the doctor about this, she said that the surgery went great and all will look great in nine months or so. Now after 7 weeks, my wife has spitting stitches, leaving open wounds and still cannot see any sign of nipples or areola. Does it look like to you that the nipples were cut by mistake or have they been saved?

Doctor Answers 4

Breast reconstruction

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I perform these operations with breast surgeons and I explain to the patient before surgery that the intent is to save the nipple areolar complex in a nipple sparing procedure.  I check the blood in the operating room and if viable it is maintained.  If it is not able to be maintained it is removed prior to inset of the flap.  A circle of the DIEP skin will be visible in that case.

Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

Nipple sparing mastectomy

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Nipple sparing Mastectomy leaves the nipple areola with all the skin of the breast. This will definately decrease the vascular supply to the nipple areola and to the skin around the incision, unless one leave a button of breast tissue under the nupple areola. This leaving of some breast tissue under the nipple areola and leaving a thick skin and fat under the mastectomy skin mat interfer with a good cancer surgery.

It is possible that your wife had nipple sparing mastectomy, but have lost skin around the incision and thus will loose the nipple. Also the nipple will shrink with nipple sparing mastectomy.

Now your wife has a skin loss and need to heal that wound. the tissue underneath seems healthy in the picture posted. If so that will heal with contineous care and may be a wound vac will accelerate the healing process.

six month to one year later the scar and tissue is evaluated and the new nipple can be reconstructed, and sometimes the size and shape of the breast may need to be adjusted. This is normal in breast reconstruction. If the full flap as survived your wife will get a very good result. In general one needs to think of breast reconstruction as a multiple procedures to achieve natural looking breast and symmetrical breast.

Samir Shureih, MD
Baltimore Plastic Surgeon

Nipple and/or areola sparing mastectomy

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Without having seen and examined your wife's breasts before the mastectomy, it is difficult to say whether her areolas +/- nipples were attemped to be saved.  I'm not sure what exactly was done during the mastectomy, but there does not appear to be any nipples at this time.  I can't tell exactly what happened to your wife, but the patients I've seen with similar presentations, usually develop post mastectomy skin flap necrosis that resulted in open wounds.  It's possible that nipple sparing mastectomy was attempted but the nipples, along with some breast skin, had died and sloughed off over the past several weeks. 

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 52 reviews

Nipples? aftetr DIEP flap

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It would have been helpful to knwo exaclty what was done by the breast surgeon and the palstic surgeon, but it looks like she had a formal mastectromy or had slough of the central skin after the skin sparing procedure. Hard to say exactly without an exam and getting more info.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.