One of the more common questions that comes up during a mastectomy reconstruction– “Should I save my nipple or should I have it removed during the mastectomy”. There are oncologic, anatomic, aesthetic, and psychological reasons to remove the nipple areola complex. It is important to understand that after a mastectomy the nipple will not have sensation and will not function normally.
From an oncologic or cancer standpoint the reasons to remove the nipple areola complex are:
- Tumors larger than 5 cm.
- Tumors within 2 cm of the nipple areola complex.
- Recurrent cancers and previous radiation.
These scenarios often indicate aggressive, high grade, or recalcitrant cancers that may need more aggressive treatment.
From an anatomic standpoint the reasons to remove the nipple areola complex are:
- A nipple in a ptotic breast with a long sternal notch to nipple distance.
In these cases the blood supply to the nipple areola complex will be signigficantly deminished or compromised after mastectomy and has a high likelihood of skin necrosis.
From an aesthetic standpoint the reasons to remove the nipple areola complex are:
- A nipple significantly asymmetric from the contralateral nipple areola complex that can not be significantly or predictably elevated.
From a psychological standpoint the reason the remove the nipple areola complex are:
- The patient will live their life more fully in the future without the possible worry of recurrence in the nipple areola complex.
The photograph demonstrates before and after unilateral mastectomy with removal of the nipple areola complex. The breast that underwent mastectomy was ptotic and the nipple areola complex was significantly out of position compared to the contralateral side and could not be corrected in a single stage mastectomy procedure.
After the reconstruction, the patients can undergo nipple areola complex tattoo placement or can have an aesthetic tattoo placed such as vines, pink ribbons, flowers, etc. All of these options can give great aesthetic outcomes.