Mastectomy techniques
Preserving the nipple does not make the operation suitable for everyone.
Nipple-sparing mastectomy removes breast tissue while preserving the outer breast skin and nipple–areola complex.
The procedure is usually combined with immediate reconstruction.
What determines eligibility?
- Tumor location
- Distance between the tumor and the nipple
- Clinical or imaging concern involving the nipple
- Breast size and degree of ptosis
- Previous breast surgery
- Smoking and vascular risk
- Previous or expected radiotherapy
- Type of reconstruction
- Surgeon and institutional experience
What happens to sensation?
Normal breast and nipple sensation cannot be expected after mastectomy.
Although the nipple remains visible, sensation may be reduced or absent because nerves are divided while breast tissue is removed.
Patients should distinguish preservation of appearance from preservation of function.
What complications should be discussed?
- Partial or complete nipple necrosis
- Skin-flap necrosis
- Infection
- Bleeding or fluid collection
- Implant or expander loss
- Delayed wound healing
- Positive tissue beneath the nipple
- Need for nipple removal
- Need for revision surgery
Conventional, endoscopic and robot-assisted approaches
Nipple-sparing mastectomy can be performed through conventional open incisions. Selected centers also use endoscopic or robot-assisted techniques, often with an incision placed near the side of the breast or under the arm.
The internal goal remains removal of breast tissue. A less visible incision does not establish better cancer control, fewer complications or greater suitability.
Questions to ask about a robotic procedure
- Why is this approach being recommended for me?
- Am I also eligible for conventional nipple-sparing mastectomy?
- How many comparable operations has the surgeon performed?
- How are surgical complications recorded and reported?
- What is the expected operative time?
- What additional costs are associated with the robotic system?
- What follow-up data are available?
- What happens if the operation needs to be converted to an open approach?