Mastectomy Options

A nipple-sparing mastectomy (NSM) is a type of breast surgery where the breast tissue is removed but the nipple and areola (the darker skin around the nipple) are preserved. For many women, this approach helps the reconstructed breast look and feel more natural, since the nipple remains in place.

How It Works

During a nipple-sparing mastectomy:

• The surgeon removes all or most of the breast tissue underneath the skin.

• The skin, nipple, and areola are left intact.

• Reconstruction (with an implant, flap tissue, or a combination) is usually performed at the same time, filling the breast pocket beneath the preserved skin.

The result is a smoother cosmetic outcome, with the natural nipple and areola as part of the reconstructed breast.

Who May Be a Candidate

Not every woman is a candidate for NSM. Surgeons carefully evaluate:

• Tumor location and size: NSM works best when cancer is not near the nipple or areola.

• Type and stage of cancer: Early-stage breast cancers, ductal carcinoma in situ (DCIS), and preventive (prophylactic) mastectomies may be good fits.

• Genetic risk: Women undergoing preventive surgery for BRCA or other mutations are often candidates.

• Breast size and shape: Smaller or moderately sized breasts with minimal sagging may be better suited.

Your surgical team will use imaging and biopsy if needed to ensure the nipple can be safely preserved without increasing cancer risk.

Benefits of Nipple-Sparing Mastectomy

• More natural appearance: Keeping the nipple and areola often helps the reconstructed breast look more like the original.

• Improved body image: Many women feel more comfortable and confident with their preserved nipple.

• Single-stage option: NSM is often performed together with immediate reconstruction, so you wake up with your new breast shape in place.

Things to Keep in Mind

• Sensation changes: Even though the nipple is preserved, most women lose sensation in the nipple and breast after surgery.

• Risk of complications: Sometimes the nipple tissue does not heal well due to reduced blood supply, which can lead to partial or full nipple loss.

• Not always possible: If cancer is close to the nipple or if skin quality is poor, your surgeon may recommend a different type of mastectomy.

• Follow-up monitoring: The preserved nipple and skin are still monitored during routine follow-up visits to ensure no cancer develops in the tissue that remains.

Emotional Considerations

For many women, nipple-sparing mastectomy provides a sense of wholeness and helps the reconstructed breast feel more like their own. For others, sensation changes or cosmetic differences can still feel like an adjustment. Both experiences are valid, and support from your care team and community can help you process the transition.

A Personal Choice

Nipple-sparing mastectomy can be a meaningful option, especially for women having preventive mastectomy or those with early-stage cancer where the nipple can safely be preserved. For many women, it is about more than saving tissue—it’s about honoring your healing and helping you move forward with confidence in your body. Like all surgical options, it comes with trade-offs, and your care team will help you weigh the benefits and limitations.