Preserve a Prominent Part of the Breast During Surgery in Austin, TX
Women exploring breast reconstruction options often focus on the breast mound itself, whether volume comes from donor tissue taken from elsewhere on the body or an implant inserted into a specially made pocket. Throughout this process, many women also wonder what will happen to their nipple—whether it can be preserved or if a new one will be built. While there are a couple of options to reconstruct the nipple, it is Dr. Christine Fisher's belief that the optimal aesthetic reconstruction is achieved with nipple-sparing breast reconstruction.
While the primary focus of breast cancer surgery is to treat cancer, careful reconstructive planning and artistic skill can create a body that patients will feel comfortable in. Nipple-sparing breast reconstruction offers the best of both worlds for the right candidates, providing full cancer treatment with a superior aesthetic outcome. During the procedure, the underlying glandular breast tissue is completely removed, while the overlying skin and nipple are preserved. This method allows the reconstructive surgeon to recreate the breast shape while retaining the patient's actual nipple, rather than creating an artificial nipple or tattooed version. The result is a beautiful, natural breast without compromising the effectiveness of the cancer treatment. Many women consider nipple-sparing breast reconstruction to result in the most realistic-looking results out of the various reconstructive options but should note that mastectomy patients must meet very specific criteria in order to be considered as candidates for the procedure. This is because nipple-sparing breast reconstruction is not right for every patient.
What is Nipple-Sparing Breast Reconstruction?
For this surgery, Dr. Fisher leaves the nipple and/or areola in place while the breast tissue underneath is removed. In most cases the incision is along the fold of the breast and is not visible on the front of the breast. The nipple is then incorporated into the newly reconstructed breast. She does not recommend "nipple banking," where the nipple is removed and saved for later breast reconstruction, due to the high rate of complications with this procedure.
During nipple-sparing breast reconstruction, the nerves to the nipple are severed, so there will be little to no feeling in the nipple afterward.
Dr. Fisher offers reconstruction for those undergoing mastectomy via DIEP flap, SIEA flap, LD flap, Gap flap, PAP flap, and silicone implant. All of these reconstructive procedures may be performed in conjunction with a nipple-sparing mastectomy.
Who is a Candidate for Nipple-Sparing Breast Reconstruction?
While nipple-sparing breast reconstruction may offer superior results for some patients, it is not the right choice for everyone. Women with a small tumor and no signs of cancer in the skin or near the nipple may be suitable candidates for nipple-sparing breast reconstruction. Lymph nodes in the axilla should also be clinically negative. For these patients, Dr. Fisher offers aesthetic nipple-sparing breast reconstruction at the time of the mastectomy.
Nipple-sparing breast reconstruction is not appropriate for every patient. If there is cancer in the skin or near the nipple, there is a higher risk cancer will reoccur if the nipple is not removed. Patients also need to understand that during nipple-sparing breast reconstruction, the nerves to the nipple are severed, so there will be little to no feeling in the nipple afterward. Dr. Fisher will discuss all the benefits and drawbacks of nipple-sparing breast reconstruction with you before your surgery so you can determine whether this procedure is the right one for you.
The Benefits of Nipple-Sparing Breast Reconstruction
For the right woman, nipple-sparing breast reconstruction offers numerous advantages:
- Reconstruction and the mastectomy are performed during the same surgery
- Evidence of surgery may be nearly undetectable as the scar is hidden in the fold of the breast
- Post-operative scarring can be minimized
- Comparable to traditional mastectomy regarding recurrence rates
- Patients may experience greater self-confidence in their appearance
The choice to undergo nipple-sparing breast reconstruction is one that needs to be made between a woman, her surgical oncologist, and her reconstructive plastic surgeon. Working with the full medical team allows her to collect all the pertinent information necessary to make a decision that will ensure safe and effective cancer treatment and the best possible cosmetic results with her reconstruction procedure.
Austin Plastic & Reconstructive Surgery
- Known for natural-looking aesthetic results in breast reconstruction and cosmetic surgery.
- Elected by peers for inclusion in Texas Monthly's Texas Super Doctors®: Rising Stars listing.
- Reconstructed over 6,000 patients, including more than 2,500 DIEP flap reconstructions.
- 4.9-star average rating over hundreds of reviews for reconstructive and cosmetic surgery.
Why Choose Dr. Christine Fisher for Nipple-Sparing Breast Reconstruction?
With extensive experience in all options for breast reconstruction, including both implant-based and living tissue (DIEP flap) reconstruction, and qualifications including being a member of the Medical Advisory Committee for the Breast Cancer Resource Center, Dr. Fisher is a board-certified plastic surgeon and fellow of the American College of Surgeons with both the surgical experience and the aesthetic skill to create a natural-looking nipple-sparing breast reconstruction, if that is an option for you. She will work closely with your oncology team and your surgical oncologist to ensure your reconstruction experience is both safe and positive.
The Difference a Personal Touch Can Make
Understanding the details of nipple-sparing breast reconstruction is important, as well-informed patients tend to be more secure in their decisions. A feeling of security lowers stress and improves healing, which is why Dr. Fisher works with each patient to explain any information available on her site—and beyond—in more detail. Each consultation gives the patient a chance to ask questions and get honest answers, as well as develop the trust necessary for any surgery.
Your Nipple-Sparing Breast Reconstruction Surgery Experience
Breast reconstruction is an extensive process that involves many different medical professionals. The multi-step process will include the following:
In addition to consulting with your oncology team and your surgical oncologist about your mastectomy or lumpectomy, you will also schedule a meeting with Dr. Fisher to discuss your options in reconstruction. During this appointment, Dr. Fisher will gather and review your health information including specifics of your cancer diagnosis and treatment. She will also want to hear your concerns and take the time to answer all your questions so you feel confident moving forward with your reconstruction. This will also be the time that Dr. Fisher gains an understanding of both your reconstructive and your aesthetic goals so she can better tailor the procedure to your needs.
The Day of Your Breast Reconstruction Surgery
Your nipple-sparing breast reconstruction will be performed at the same time as your lumpectomy or mastectomy under general anesthesia. Dr. Fisher will make an incision underneath the breast in the crease, allowing for access to the underlying tissue. She will leave the nipple and areola in place while the tissue underneath is removed and replacement tissue or an implant is placed into the breast cavity. The nipple is then incorporated into the newly constructed breast.
Dr. Fisher advises her reconstruction patients against "nipple banking," which entails removal of the nipple to save it for breast reconstruction at a later time. There is a high rate of complications with this procedure, making it very difficult to achieve positive results for the patient. If the nipple cannot be spared, Dr. Fisher considers nipple reconstruction or 3D tattooing of the nipple-areolar complex to be a safer choice.
Once the breast reconstruction is complete, Dr. Fisher will close the incision using layers of dissolvable sutures. A surgical bra will need to be worn after the procedure to provide adequate support to the breasts and reduce post-operative swelling. You will probably stay in the hospital at least overnight for observation since you will be undergoing both your surgical procedures at the same time.
What is the Nipple-Sparing Breast Reconstruction Timeline?
Recovery after nipple-sparing breast reconstruction starts at the facility after your surgery is finished. Upon returning home, patients are encouraged to continue to avoid strenuous activity for four to six weeks in order to give their new breasts time to properly heal. Many patients return to work within four to six weeks of their surgery. Recovery from surgery will vary based on whether you have a lumpectomy or mastectomy and will also depend on how the reconstruction was performed—whether an implant was used or flap reconstruction was done.
Download Our Breast Reconstruction Post-Operative Care Guides
We've compiled detailed post-operative care instructions to best equip our breast reconstruction patients throughout their recovery process. To ensure the best and safest recovery, your plan encompasses appropriate prescriptions and clear directions towards maintaining your comfort to get you back to normal life and activity as soon as possible. Individual patients respond uniquely, and the type of procedure may differ, but these basic guidelines will help you along your journey.
What Are the Options for Women Who Are Not Candidates for this Procedure?
At Austin Plastic & Reconstructive Surgery, women who are not good candidates for nipple-sparing breast reconstruction may choose to have a new physical nipple created from the skin at the top of the breast mound that is later tattooed for natural coloration, to have just the tattooing done, or to have no appearance of a nipple at all. Tattooing is offered in Dr. Fisher's office by a licensed medical tattooist with more than 10 years of experience in nipple-areolar complex restoration. Dr. Fisher works with each patient to help her be as informed as possible when making this very personal decision.