Nipple sparing mastectomy reconstruction? (Photo)

Question

I’ve got large breasts andwas told I can’t have NSM because nipples need to be lifted but that they’d be numb regardless. Was hoping for a small rebuild with fat transfer, not DIEP due to recovery/belly scar. Not interested in implants/maintenace. DIEP with longer recovery, scars and follow up surgery to get nipples seems like having a numb imitation body instead of enjoying one. Feeling discouraged any 3rd options? If they don’t do anything why reconstruct them. Feels like pointless advertising

Ryan Rebowe, MD · Answer

To clarify, it is true that nipple sparing mastectomy can typically only be performed on breasts where the nipples are relatively high (a more technical definition would be a short sternal notch to nipple distance). Nipple sparing mastecomy does have several advantages. It allows for the sparing of all skin so that you can utilize a full sized breast implant instead of starting with an expander. It is also cosmetically superior to a formal nipple reconstruction, however this can be debated as many 3D nipple tattoos look very good. It is important to note with modern techniques you can still get a very nice result with a skin sparing (i.e. non-nipple sparing) mastectomy. For example, a vertical pattern or wise pattern mastectomy can wind up more like a breast lift than a mastectomy. I would ensure that you are utilizing a mastectomy surgeon with a formal breast fellowship as well as a plastic surgeon that performs a good amount of breast reconstruction in their practice.

Gary M. Horndeski, MD · Answer

Your breasts are low on the chest wall and quite ptotic. The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique can also be used for mastectomies.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

With a mastectomy, the nerves in the breast tissue are removed, so you will not have sensation regardless of the type of reconstruction. The mastectomy is done to treat or prevent cancer and to save your life. Not all women choose to have reconstruction. If you don't want reconstruction, then don't have it. It can always be done later.  Reconstructed breasts are to help you feel better, especially in clothing. They are no longer sex toys.

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