Nipple-Sparing Mastectomy Q&A with Dr. Tsangaris

Theodore Tsangaris, MD, MBA, FACS

“I can’t tell you how many women come into my office and tell me they want what Angelina Jolie got,” said Dr. Theodore Tsangaris, Surgical Director of the Breast Care Center at the Sidney Kimmel Cancer Center at Jefferson Health. What he’s referring to is a nipple-sparing mastectomy (NSM), a reconstructive surgery procedure that removes the breast tissue while preserving the breast skin and nipple—unlike total mastectomies that remove the entire breast, and can result in devastating psychological pain for some patients. “A woman’s breasts and nipples are very emotionally charged parts of the body,” explains Tsangaris. “For me, it’s the first option I present to my patients.”

Read on for more information on what exactly a NSM is, who is a candidate and what you need to know about this procedure that grows in popularity every year.

What is a nipple-sparing mastectomy?

A NSM preserves the nipple, areola and the envelope of the breast. This is not your grandmother’s mastectomy. It is designed to not only get the cancer out, but unlike the past, we’re now approaching mastectomies in a cosmetic way, and working together with plastic surgeons who do such a wonderful job with new implants and tissue reconstructions, I can often tell women that they actually look better after their breast cancer than they did before. Our understanding of the disease has evolved. We now know that taking all of the skin and the nipple and areola doesn’t make for a better cancer operation.

Who is a good candidate for a nipple-sparing mastectomy?

Traditionally, women with small tumors or tumors that are away from the nipple are good candidates. Unless the cancer is growing right underneath, or into the nipple, the mastectomy can be done. However, I also have to ask, is it going to look good? Women who need significant breast reconstruction surgery, such as a lift or a reduction, will not be happy with a NSM and need to see a plastic surgeon.

I have been performing NSM since the 90’s, before it used to be “show me a person who can have a NSM,” now it’s “show me something who can’t have it.”

Can you discuss the quality-of-life outcomes associated with NSM?

I have conducted numerous studies on quality-of-life outcomes following mastectomies. Women have better self-esteem and tend to be more self-motivated, they’re more comfortable with their disease and they go back to work sooner.

Are there any risks? What could go wrong?

This type of mastectomy, like any other, requires there to be a conversation between physician and patient. A NSM leaves a little bit of breast tissue behind, and although it is not show itself to be of great concern, it is something people need to think about. Patients should also know that there is always a risk no matter how well the mastectomy is performed, that it is a possibility that for uncontrollable reasons, the nipple just doesn’t survive. Those reasons could include anything from technique to other unique patient factors.

What is the recovery time?

This type of mastectomy doesn’t require any sort of recovery time different than any other mastectomy.  The recovery time really depends on what kind of reconstruction the patient has received. If it is just implant reconstruction, they can get back to work fairly quickly…a matter of weeks.

Cancer recurrence is a scary possibility patients face after going through treatment. Is there any difference in recurrence rates when you receive a nipple-sparing mastectomy vs non nipple-sparing mastectomy? 

No. A nipple-sparing mastectomy is ontologically safe and there is no difference.

For more information about tests & treatments, and the Jefferson Breast Care Center at the Sidney Kimmel Cancer Center at Jefferson Health, call 1-800-JEFF-NOW or visit JeffersonHealth.org/cancer.

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