Here is some insight:
FORCE MAIN MESSAGE BOARD:
TOPIC: "REMOVE OR KEEP MY NIPPLES"
-there is a 5-10% chance either way. there have been 2 recent studies, one from sloan kettering and one from georgetown, both of which found that NS did not increase chances of cancer. one or both were retrospective. i remember in one study, only one person had a recurrence, and her surgery had been for DCIS, not prophylactic. there should be citations for these studies on the boards somewhere.
-I'm in my mid-40s, BRCA2, and I had breast cancer. My bilateral mastectomy was performed one year ago, with my breast surgeon - chief surgeon at a major cancer/academic medical center -- recommending that I keep my nipples (even the one on the cancer side). I did so, and I'm so thankful for his recommendation on a daily basis! NSM is harder for surgeons to perform, so please make sure you ask how many of these he/she has done. According to one study, "NSM has been considered safe in women with small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy." http://www.ncbi.nlm.nih.gov/pmc/article ... 921821.pdf. Good luck with your decision.
TOPIC: "NIPPLE SPARING LONG TERM STUDY"
-Here is another supportive ten year study released recently by MSKCC!!!
http://www.ncbi.nlm.nih.gov/pubmed/21847697
Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience.
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Abstract
BACKGROUND: Nipple-sparing mastectomy (NSM) has been gathering increased recognition as an alternative to more traditional mastectomy approaches. Initially, questions concerning its oncologic safety limited the use of NSM. Nevertheless, mounting evidence supporting the practice of NSM for both prophylactic and oncologic purposes is leading to its more widespread use and broadened indications.
METHODS: Using a prospectively maintained database, we reviewed our experience of 353 NSM procedures performed in 200 patients over the past 10 years.
RESULTS: The indications for surgery were: 196 prophylactic risk-reduction (55.5%), 74 ductal carcinoma in situ (DCIS) (20.8%), 82 invasive cancer (23.2%), and 1 phyllodes tumor (0.5%). The nipple areolar complex (NAC) was entirely preserved in 341 mastectomies (96.7%). There were 11 patients (3.1%) who were found to have cancer at the nipple margin, warranting further excision. A total of 69 breasts (19.5%) had some degree of skin desquamation or necrosis, but only 12 (3.3%) required operative debridement, of which 3 breasts (1%) necessitated removal of a breast implant. Also, 6 patients (2%) were treated for infection. Of the 196 prophylactic NSMs, 11 specimens (5.6%) were found to harbor occult cancer (8 DCIS and 3 invasive cancers). One patient who underwent NSM for invasive ductal carcinoma in 2006 developed metastatic disease to her brain. No other recurrences are attributable to the 353 NSMs.
CONCLUSIONS: The trends demonstrate the increasing acceptance of NSM as a prophylactic procedure as well as for therapeutic purposes. Although NSM is not standard, our experience supports the selective use of NSM in both prophylactic and malignant settings.
-http://explore.georgetown.edu/news/?ID= ... lateID=295
Georgetown University Medical Center
| FOR IMMEDIATE RELEASE: October 27, 2011 | |
| CONTACT: | Karen Mallet (media only) km463@georgetown.edu |
 | |
Georgetown Researchers Examine 21-Year Series of Nipple Sparing Mastectomy Cases and Find No Cancers | |
WASHINGTON, D.C. -- A new study suggests some women needing a lumpectomy or mastectomy to treat their breast cancer have another potential option that is safe and effective, say researchers at Georgetown. They say the procedure known as a nipple sparing mastectomy is also a viable surgical option for women who choose to have their breasts removed because of their increased risk of developing the disease. For both groups of women, the surgery offers a chance for a more natural looking and normal feeling reconstructed breast as compared to other forms of mastectomy. Nipple sparing mastectomy (NSM) involves the removal of the breast tissue while keeping intact the breast skin and nipple areola complex, which includes the nipple and darker pigmented circle of skin that surrounds it. The breast is usually reconstructed immediately. A long standing concern with this type of surgery is that cancer cells might be left under the nipple, posing a threat over time. To examine the effectiveness of NSM, surgeons conducted a review of patient records for all women receiving the surgery at Georgetown University Hospital (GUH) between 1989 and 2010 including surgeries to either prevent or treat breast cancer. The results are published in the November issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons. “Our findings were reassuring. Of the 162 surgeries performed, we found no cancer recurrences and no new cancers in those receiving NSM,” says Scott Spear, M.D., professor of plastic surgery at Georgetown University Medical Center and chairman of the department of plastic surgery at GUH. “The nipple-sparing technique is not appropriate for every patient depending upon their anatomy and type of breast pathology. Careful selection of the right patient for NSM is an important element of success.” Some patients who received NSM at Georgetown had early-stage cancer or DCIS, which can become an invasive cancer if not treated properly. In fact, while the majority of women with early cancers typically have a lumpectomy, many women choose to have a mastectomy. Georgetown breast cancer surgeon Shawna C. Willey, M.D., says the first priority always is to treat or prevent the cancer. “We need to be able to offer women options that they know will successfully treat or prevent their cancer while at the same time, preserve their quality of life whether it be in their appearance or psychologically. Nipple sparing mastectomy goes a long way toward reaching that goal.” Willey is chief of breast cancer surgery at GUH, and she and Spear are members of the Georgetown Lombardi Comprehensive Cancer Center. One step credited for why cancers didn’t develop later is that biopsies were done on the tissue that remained under the nipple area after the NSM. If abnormal cells in this tissue were identified, as it was in four cases reviewed, either the nipple or entire nipple areola complex later were removed. A second concern for this kind of surgery is that the nipple areola complex (NAC) might not receive enough blood after the tissue and blood vessels below it are removed causing necrosis or tissue death. Researchers say the records showed three NACs became necrotic and required removal. Four other NACs had partial necrosis requiring surgery though the nipple and majority of the areola was spared. “What we’ve learned from this review is that our established procedures and patient-selection protocol lead to favorable results,” confirms Spear. “As more data become available, I think we’ll see nipple sparing mastectomy play a larger role, particularly in the prevention setting.” This work was not supported by any external funding. In addition to Spear and Willey, authors include Elizabeth D. Feldman, M.D., Costanza Cocilovo, M.D., Mary Sidawy, M.D., Ali Al-Attar, M.D., Ph.D., Catherine Hannan, M.D., Laura Seiboth, M.D., and Maurice Y. Nahabedian, M.D. Spear and Nahabedian are paid consultants to Lifecell and Allergan Corporations. None of the remaining authors report having personal financial interests related to the study. About Georgetown Lombardi Comprehensive Cancer Center Georgetown Lombardi Comprehensive Cancer Center, part of Georgetown University Medical Center and Georgetown University Hospital, seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future. Georgetown Lombardi is one of only 40 comprehensive cancer centers in the nation, as designated by the National Cancer Institute, and the only one in the Washington, DC, area. For more information, go to http://lombardi.georgetown.edu. About Georgetown University Medical Center Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization (BGRO), which accounts for the majority of externally funded research at GUMC including a Clinical Translation and Science Award from the National Institutes of Health. In fiscal year 2010-11, GUMC accounted for 85 percent of the university’s sponsored research funding. | |
If I get my nipples removed and have nipple reconstruction...here is some good insight:
-My plastic surgeon has also advised me to wait 3 months or more after the swap for the nipple reconstruction. He thinks I will be happier with that timing because the implants will have a chance to settle in and the nipple will look more natural. He stressed he will reconstruct nipples when he swaps if I am feeling in need of them then, but he advises waiting. I am choosing to wait because I have already invested so much time and effort in the process that I figure what's a few more months to be happier with the end result.
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