Improving Options for Nipple-Sparing Breast Reconstruction
The nipple delay procedure is a surgical technique that can help improve blood flow to the nipple and surrounding breast skin before a nipple-sparing mastectomy. For some patients, particularly those with larger breasts, previous scars, radiation, or increased skin laxity, this additional procedure may help make nipple-sparing reconstruction a safer option.
Dr. Nadia Blanchet has extensive experience with breast reconstruction and can discuss whether a nipple delay may be appropriate as part of your individual reconstruction plan.
What is Nipple Delay?
Nipple-sparing mastectomy has revolutionized mastectomy reconstruction outcomes. The patient keeps her nipple areolar complex, and the scar is often able to be hidden below the breast reconstruction. Since a scar on the breast also influences the shape of the breast, the resulting reconstruction has a prettier, rounder shape.
Nipple-sparing mastectomy (NSM) does, however, have more risk because since more skin is saved, it has a poorer blood supply. This can translate into more wound healing issues in terms of infection, skin loss, nipple loss and even implant loss. This is especially true in large breasted women, irradiated breasts, breasts with scars or breasts that have more droop and therefore more skin.
The Journal of Surgical Oncology in 2012 introduced a technique to counteract these problems. It is called a “surgical delay” procedure, and it gained some popular attention after Angelina Jolie had this procedure prior to her bilateral prophylactic mastectomies with reconstruction.
The nipple delay procedure is performed by the cancer surgeon and involves making the same incision as would be made for the mastectomy and then releasing the undersurface of the nipple and surrounding skin from the breast for about two inches. It allows the blood vessels in the skin under and around the nipple to dilate so that when the mastectomy is performed about two weeks later, the nipple has already accommodated to the new circulation pattern and will survive.
You can read about this under Publications – “Surgical Delay of the Nipple Areolar Complex in High-Risk Nipple-Sparing Mastectomy Reconstruction.”
What Happens During a Nipple Delay?
If the patient has cancer, then the tissue under the nipple will be biopsied at the time of the delay to make sure that the nipple can be saved from a cancer point of view. The lymph nodes can be sampled at this time as well. This allows the patient to have a shorter operation at the time of the mastectomy.
Benefits and Considerations
In summary, the nipple delay procedure has the disadvantage of an added operation. The advantages are allowing more patients to be candidates for nipple-sparing mastectomy, safer surgeries with fewer complications and dramatically increasing the chances that we will be able to skip the expander to go directly to implant (DTI).
For patients considering breast reconstruction, the nipple delay procedure may provide another option for improving the likelihood of preserving the nipple and achieving a natural-looking reconstruction. Whether it is appropriate depends on your breast anatomy, medical history, cancer treatment, and overall reconstruction plan.
I will be very happy to discuss this procedure with you in more detail when you come in to discuss and plan your breast reconstruction.
Important Post-Procedure Follow-Up
IMPORTANT: On the day after your nipple delay procedure, I need to see you in person in the office or you must email pictures of your breasts. If I am not in the office, you should make an appointment to see the surgeon who performed the delay procedure the day following your surgery.
The nipple delay procedure is an additional step in the reconstruction process, so careful follow-up is important to monitor the nipple and surrounding skin before the mastectomy is performed.
Let’s Talk Through Your Options
Every patient’s journey is unique. During your consultation, we’ll take the time to understand your goals, answer your questions, and create a plan that feels right for you. Schedule your consultation today.
Additional Information
Find Before and After Photos, Instructions, and Videos here: