Mastectomy Options

An areola-sparing mastectomy (ASM) is a type of breast surgery where the areola (the darker skin around the nipple) is preserved, but the nipple itself is removed along with the breast tissue. This approach provides a balance between safety and cosmetic outcome, leaving the areola for a more natural-looking reconstruction.

How It Works

During an areola-sparing mastectomy:

• All or most of the breast tissue is removed.

• The nipple is removed, since the tissue inside carries a higher risk of cancer.

• The areola is preserved, keeping part of the natural breast skin for reconstruction.

• Reconstruction with an implant or natural tissue (flap) is often performed at the same time, filling in the breast beneath the preserved skin.

The end result leaves the natural circular areola in place, which can make later refinements (like nipple reconstruction or tattooing) blend more seamlessly.

Who May Be a Candidate

Areola-sparing mastectomy may be considered if:

• The cancer is not close to the areola or nipple area.

• You are undergoing surgery for preventive reasons (such as BRCA or other hereditary risk).

• Your breast and skin quality allow for safe preservation of the areola.

• You are planning immediate reconstruction.

Your surgeon will carefully review your imaging, tumor location, and health history to determine if this option is appropriate.

Benefits of Areola-Sparing Mastectomy

• More natural appearance: Keeping the areola helps the reconstructed breast look less “surgical” and more like your natural chest.

• Improved cosmetic results: Later nipple reconstruction or 3D tattooing can be matched directly within your preserved areola for a realistic look.

• Emotional comfort: Some women feel more at ease retaining part of their natural breast appearance.

• Reconstruction flexibility: Works well with both implants and flap procedures.

Things to Keep in Mind

• The nipple is still removed: This procedure is different from a nipple-sparing mastectomy—sensation and projection are not preserved.

• Not for everyone: If cancer is too close to the nipple-areola complex, the areola may need to be removed for safety.

• Possible healing issues: Like nipple-sparing surgery, preserving skin carries a small risk of reduced blood supply, which can affect healing.

• Sensation changes: Even with the areola preserved, sensation is usually lost or greatly diminished.

Emotional Considerations

For many women, keeping the areola provides a greater sense of normalcy after mastectomy and makes reconstruction feel more natural. For others, the absence of the nipple or the loss of sensation can still be an adjustment. Both experiences are valid, and support is available as you process your healing.

A Personal Choice

Areola-sparing mastectomy offers an option between skin-sparing and nipple-sparing surgery, helping preserve as much of the breast’s natural appearance as possible while prioritizing safety. It allows you to preserve part of what makes your breast look like your own, while still focusing on safe, effective cancer treatment.