Double Mastectomy. Is Having the Skin and Nipple Sparing Mastectomy the Best Way to Achieve the Most Natural Looking Breast?

Doctor Answers 5

Skin sparing mastectomy, direct to implant plus Alloderm for natural result

If your cancer team agrees that skin and nipple sparing mastectomy is a reasonable option, then you should consider the option of direct to implant (DTI) reconstruction which uses Alloderm as an internal bra. Sometimes a tissue expander is used when DTI is not suitable, but in most cases the primary reconstruction can be done at the same time as the mastectomy. I also recommend Exparel for pain reduction. Recently we did a bilateral case, with DTI, Alloderm and Exparel and she was out of the hospital in 24 hours, all done and no more surgery.

Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews

Breast reconstruction

There are a couple of details that need to be understood.  Are you BRCA+?  Are you in an area where the breast surgeons feel comfortable with the nipple sparing techniques?  Have you found a Plastic Surgeon to provide a comprehensive consult about all the options?

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 and Skin Sparing Mastectomy

There are two determining factors to the use of a Nipple and Skin Sparing Mastectomy:

1.   From an oncologic standpoint, your mastectomy surgeon will need to feel comfortable leaving the nipple and still obtaining clear margins around the cancer.    

2.  From a reconstruction standpoint, your plastic surgeon will need to feel comfortable that your nipple has a good chance of survival from a blood supply standpoint.    Generally, the further the nipple is from the inframmammary fold (crease), the higher the risk of nipple loss.      If there is too much skin to allow for a safe reconstruction, your plastic surgeon will need to remove some of this skin and the corresponding nipple.  

I would recommend consultation with a board certified plastic surgeon with experience in both tissue and implant breast reconstruction.

Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 82 reviews

Care plan for natural results

A skin sparing mastectomy may be an option for you.  And sparing the nipple will depend on your cancer diagnosis.  In some cases, its not a good idea to keep the nipple.   In terms of reconstructive options, your options will depend on your cancer treatment plan.  Please see a board certified PS to learn more about your options.

Dr. Basu

Nipple Sparing Mastectomy

Hi. I'm sorry that you are going through an obviously super tough time.

Yes, a nipple sparing mastectomy (NSM) is the best way to achieve a natural and good looking reconstructive result.  The first step is to make sure that you are a candidate for this procedure (your cancer surgeon will decide based on the location of the tumor and its size). You should have see a plastic surgeon before you have mastectomies so that s/he can help plan the operation and reconstruction.

Good luck and feel free to email or call if you have further questions.

Gil Kryger, MD
Thousand Oaks Plastic Surgeon
4.6 out of 5 stars 11 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.