Plastic Surgeon Questions Breast Cancer

Mom died of breast cancer- need feedback on nipple sparing masectomy

I currently have had breast implants for 10 years. My mom recently passed of breast cancer and I am thinking of when it is time to change my implants I will do a nipple sparing mastectomy to avoid my risk of developing breast cancer. Is this a lot more major then a regular augmentation, and how do the results turn out, do they look good- will I need to use expanders?

14 Answers

This procedure is more complicated It will leave you with numb nipples and possible loss of nipples. If there is cancer near the nipple the general surgeon will decide if the nipple has to be taken. So yes this is more major than an augmentation.
This is a great question. There are a couple of issues that come up here.
Have you been tested for BRCA? I would start with that. If you want to
pursue bilateral mastectomies after doing that, I would suggest a consult
with myself and the breast surgeon I work with.
We would determine whether nipple-sparing would work for you. Since you
already have implants, immediate reconstruction without expanders is a
distinct possibility.
I am happy to see you for a consult to help get the process started.
Let me know...
I'm sorry for your loss. Definitely there is a challenge to perform a mastectomy with implants already in place, and then subsequently replacing them, but is a common option with many patients in the same situation as you. However, and insurance company generally will not reimburse a bilateral prophylactic mastectomy unless you have met certain criteria, including gene testing. My best advice is to come for a consultation to understand all that is involved.
Hi and thank you for reaching out with your question. I am also very sorry to hear about the passing of your mother. The questions you bring up are very important and have many implications. The decision to undergo the treatments you mention are very personal and require a candid and open conversation with a specialist surgeon in person. Someone who would be able to learn your medical history and examine you to be able to offer some guidance on this important decision. There are many questions and tests that can now be offered to decipher the risk of developing breast cancer in the wake of first-degree relative developing the illness. As such, it is important that you take your questions for a thorough face-to-face consultation.
In general, breast reconstruction after total mastectomy for prevention can be accomplished through the use of implants that go under the muscle or through the use of tissue from other areas of the body depending on the context of the patient.
Let me start by saying how sorry I am to hear of your loss! I am sure the fact that she succumbed to breast cancer has made you anxious about your own risks. Before embarking too far down the road of prophylactic mastectomy, I would strongly urge you to get tested for the BRCA gene, If you are positive for the gene, I would completely agree with pursuing prophylactic mastectomies.

That being said, it is possible to perform nipple-sparing-mastectomy, and proceed directly to implant reconstruction. The decision would partly depend on your individual circumstances, and the evaluation by a qualified plastic surgeon. There is a chance that tissue expanders might be indicated to get the best result. There might also be a role for using a decellularized sling to reinforce the reconstruction, whether going straight to implant or using tissue expanders. In my hands, either approach does not significantly change how the surgery is. Results can be very good to excellent.

I hope this is helpful. Good luck to you.

Dr. W.G. Miles
Thank you for your question. Very sorry to read about your mom. One consideration would be if she was diagnosed before or after menopause. My second question would be if your mom or you have had genetic testing. Have you had any mammograms yet, given your family history? Anyone other than your mom in your family with breast or ovarian cancer history?

From your question, it is apparent you are contemplating a nipple sparing mastectomy. This is a well accepted procedure not only in patients with your history, but also in patients with malignant lesions, provided the tumor is not in proximity of the nipple/areola and biopsy inside the nipple during surgery is negative. Usually, the breast can be removed through an incision placed around the lower half of the areola . Without getting too much into surgical detail, generally the outcome is aesthetically pleasing. Of course other procedures may be needed at the same time such as a breast lift, padding with soft tissue or by other means. Good luck to you.
Sorry to hear of your mothers passing. Whether or not risk reduction bilateral mastectomy is a recommended option should be determined either by genetic testing or discussion with your breast surgeon. That being said, Having the prior augmentation should make any breast reconstruction easier to undergo and generally would not require expanders.
Hope that helps answer your question.
Best of luck
Dr. Herbstman, MD FACS
This is a way bigger operation than just an augmentation . It may require removal of some skin, placement of larger implants an placement of temporary drains. It can also result in death of the nipples.

You would need to come in for a complimentary consultation to discuss this with the doctor. However, just to let you know, he does not perform


Rachel Samson
Patient Coordinator
This is a more extensive surgery than implant exchange alone but risk reduction nipple sparing mastectomy can have beautiful outcomes and significantly reduce your risk of getting breast cancer. Best next steps are to discuss with both a plastic and breast oncologic surgeon who team up to do this work regularly.


Jacobson Plastic Surgery
(507) 398-1900
You would need an exam first, and then I could suggest options that might be available.
There are many factors that weigh upon my decision to directly place an implant in breast reconstruction. Foremost is the blood supply to the mastectomy flaps, risk factors (smoking, diabetes, weight of pt) and size of the breasts. Talk to your breast surgeon about genetic testing. The short answer is yes, if all things are perfect. I go directly to an implant in over 75% of candidates.

William A Stefani MD
The appearance and feel after a nipple sparing mastectomy will never be as good as what you have at present. The surgery is not necessarily more painful, but the end appearance and result will not be as good. You need to weigh that in comparison to monitoring yourself for breast cancer. I suggest getting an MRI scan with a breast coil over a mammogram as it detects tumors much earlier if you want to keep the implants you have. Many surgeons promote exchanging implants in 10 years but as long as they are not broken or you are having another problem, I would leave them alone.
Hi there! Sorry to hear about your loss. Yes, mastectomy and implant-based reconstruction is a much bigger event than simple implants. The results are strongly tied to the amount of fat that the breast cancer surgeon is able to leave behind. Thin mastectomy flaps rarely give great results, and thick skin flaps can give results that are comparable to cosmetic implants. I prefer to use tissue expanders as a first stage in that reconstruction, as it allows your plastic surgeon to take some pressure out if the skin is struggling to recover after your operation. Going straight to implants at the time of mastectomy can work, but if your skin is struggling, your surgeon has very few maneuvers to help it survive.