There is a lot to consider when choosing between a lumpectomy and a mastectomy for breast cancer. In some cases it’s not possible to save the nipple. It’s something that many women don’t really think about until after surgery but can cause a shift in your self-image and even your sex life. Let’s talk about what you can discuss with your surgeon and what you might expect after surgery.
Do All Mastectomies Result in Loss of the Nipple?
A mastectomy is the removal of the entire breast, and in some cases, some of the chest wall muscle, in order to remove all of the cancer. This doesn’t necessarily mean the nipple needs to be lost. But it can’t be saved in all cases.
Mastectomy vs Nipple-sparing Mastectomy
A simple or total mastectomy involves the removal of all of the breast tissue, the skin of the breast, and the nipple and areola. Usually, this procedure will also involve lymph node removal under the arm on the side of the body where the tumor was found. They’ll be checked to see if the cancer has spread there.
Nipple-sparing mastectomy
With a nipple-sparing mastectomy, the breast tissue is removed, but the nipple, areola, and skin of the breast are left intact. Some lymph nodes will probably be removed as well. Some of the tissue from beneath the nipple and areola may be removed to help check for cancer cells. If cancer is found in this location, the nipple would then need to be removed.
Sometimes, the nipples will have to be removed later on in a separate procedure if the blood supply is not good and the area develops necrosis or tissue breakdown. Usually, breast reconstruction will immediately follow nipple-sparing mastectomies. Not everyone is a candidate for nipple-sparing mastectomies. Some factors that may make a person ineligible for this type of mastectomy include: being a smoker, having scarring around the nipples, or having had radiation to the breast.
Do You Get to Keep Your Nipple With a Lumpectomy?
If mastectomy makes it more likely that the nipple will be removed, do lumpectomies allow you to keep it? The answer is based on where the cancer is located in the breast. Some lumpectomies will include the removal of the nipple, especially if the cancer is in a duct leading to the nipple or in another part of the breast where keeping the nipple isn’t possible.
Surgical Solutions for Nipple Reconstruction
Surgical reconstruction of the breast and nipple can give many women a psychological boost to help them with self-image and confidence. Some common approaches to nipple reconstruction include:
- Skin flap reconstruction. This surgical procedure involves raising small flaps of skin near the area where the nipple would be located. They are then folded and sewn together to create a new nipple.
- Skin graft reconstruction. This procedure involves using a small piece of skin from a different area of the body to create the nipple.
- Nipple nerve reconstruction. This procedure helps to restore feeling in the nipples and breast area.
Typically, nipple reconstruction procedures are done about three months after a breast reconstruction surgery since this allows the breast time to heal before creating the nipple.
If surgery to reconstruct a nipple isn’t possible, or if you’d like a more realistic looking nipple area after reconstruction of that area, there is also an option for medical tattooing. After a surgical reconstruction method has healed, it’s possible to have a nipple and areola tattooed to look more realistic. Medical tattooing can also be done on its own, creating the appearance of a nipple without the actual raised skin.
Psychological and Emotional Impact of Nipple Loss
Anything that alters your body’s appearance can have a serious impact on your emotional well-being, and nipple loss from breast cancer surgery is no exception. Even if you had nipple reconstruction, you may feel uncomfortable or upset about your body, or your body may feel unfamiliar to you.
If you experience nipple loss due to breast cancer surgery, you may face psychological challenges like anxiety or depression, but help is always nearby. Getting professional psychological help and turning to the community for support can help you overcome these challenges. Look for a local support group to help you connect with other cancer survivors who can relate to your situation.
Sexual Impact of Nipple Loss
For many women their nipples are an important part of stimulation and orgasm. Without them, they may not feel the same type of arousal. For some, nipple reconstruction may be possible, although the same nerve endings that were in that area before surgery may not be there with a reconstructed nipple. Talk to your partner about this and any discomfort you may feel after you’ve recovered from surgery and you’re ready to have sex. You may be able to find other ways to get stimulation that you hadn’t tried before. Sometimes, nerve reconstruction can be performed immediately during a nipple-sparing mastectomy. Talk with your doctor about whether this is an option for you.
Things to Know Before Breast Cancer Surgery
While nothing can completely replace the look and feel of your nipple, it’s possible to have a healthy sex life and a positive self-image after breast cancer surgery. Talk to your oncologist and surgeon about your concerns as you discuss the type of surgery that’s best for you.
Make sure to spend some time thinking over any questions you may have and spending extensive time discussing these concerns with your doctor. They may even be able to direct you to talk with someone who will share their personal experience so you can learn more from a first-hand breast cancer survivor about nipple sparing surgeries, nipple reconstruction, and nipple tattooing. They can also talk with you about how this can impact your mental health and sexual health.
Choose an Experienced Breast Cancer Surgeon to Support You
At Rocky Mountain Breast Specialists, our dedicated team of breast cancer doctors and surgeons are here to guide you through the process of breast cancer surgery. Even if your surgeon is not on the RMBS team, our breast cancer oncologists work closely with the surgeons in our region to create a personalized plan for you based on the type of breast cancer, where it’s located in the breast, the stage, and your personal preferences.
If you or a loved one is facing breast cancer surgery in Denver, Colorado Springs, Boulder, or throughout the Front Range, request an appointment with one of our specialists for a consultation about what can work best for you.
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