A new study published in the journal Plastic and Reconstructive Surgery found that some women who need a lumpectomy or mastectomy have a third, perfectly safe option for treatment. The NSM or Nipple Sparing Mastectomy.
There are essentially two main paths for surgery when breast cancer is detected. The first less aggressive is just to remove the lump and the tissue around it (lumpectomy). The second is to remove the entire breast. Obviously the first option is less damaging and leaves a women's breast looking relatively normal, but it carries an 8-12 % risk of a recurrence, whereas the second removes the entire breast which can be traumatic in and of itself, before considering the issues of the cancer.
The third option now becoming more common is the nipple saving mastectomy, which leaves the skin, nipple and peripheral breast tissue intact. It also allows for immediate reconstructive surgery, meaning a quicker overall recovery time and less psychological trauma for the women having breast surgery.
Dr. Scott Spear, chairman of the department of plastic surgery at Georgetown University Hospital and co-author of the study said :
"Nipple sparing mastectomy as compared to other forms of mastectomy is becoming more common, and the surgery is usually successful in terms of achieving good breast reconstruction with a low risk of complications ... There's a low risk of finding breast cancer or disease beneath the nipple in those patients who are offered nipple sparing mastectomy."
Of course the concern with leaving peripheral tissue is that the cancer might spread if a fragment is left behind or might remain dormant for sometime before returning. With this in mind researchers reviewed 169 NSM surgeries at Georgetown University Hospital. They found no new cancers or recurrences within 30 months of surgery.
"There have been psychological studies to assess how women feel after having nipple sparing surgery compared to when the nipples have been removed ... There is a dramatic difference shown that women are psychologically better off, in terms of self-esteem and sense of self, than those who have had the nipple removed. One of the appeals to this surgery is that you don't have to remove the breast skin and the nipple so it's similar to breast conservation."
Still NSM is not appropriate for all women, and whilst it partly depends on the practicalities of location and size of the tumor and the size of the women's breasts, there is also a concern that women are choosing to under go more aggressive procedures than really necessary; in part because of better and immediate reconstructive surgeries that are available and also because they feel safer doing more.
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, who has been treating women for more than 30 years, agreed :
"It appears that some of these women who could have less aggressive surgery are opting for mastectomies for their own reason ... The risk is that people who influence other people, celebrities or other people in the media, may make a pronouncement that might lead other women to get a mastectomy when they don't really need it."
It does seem that more and more women are choosing to get aggressive removal of all breast tissue whilst preserving the appearance, but what is really more important is that they weigh all their options and also make sure their surgeon is experienced with the procedure they opt for. NSM is not a guaranteed option, there is always the chance of some cancerous tissue being left behind and there is also the possibility that blood supply to the nipple is lost.
Lichtenfeld concluded :
"What really scares me is that I went through the era where women were disfigured after mastectomies ... Women were not as willing to come to the doctor if they felt a lump out of fear of disfigurement. I begin to wonder whether the prevalence and pronouncement of getting mastectomies will set us back, and women will be afraid that, if they feel a lump, they only have the option of mastectomy ... if a woman makes an informed decision, then whatever she decides for a treatment option is acceptable."
Written by Rupert Shepherd