By Jordan D. Frey MD
Breast cancer continues to affect nearly 1 out of every 8 women in the world. Many of these women will ultimately undergo a mastectomy, or breast removal, surgery to cure the cancer. Thankfully, over the past decades, the surgical treatment of breast cancer has evolved dramatically. Many women now are candidates for skin-sparing or even nipple-sparing mastectomy – surgeries in which the majority or all of the breast skin can be preserved. Further, advances in breast reconstruction allow for immediate reconstruction at the same time as mastectomy. Safety of these surgeries and aesthetic outcomes are generally excellent and include options to use breast implants or your own tissue to reconstruct a new breast.
However, correcting one surgical outcome after mastectomy has proven elusive. And that is breast and nipple sensation. Unfortunately, during a breast removal procedure, many of the nerves supplying sensation to the breast skin are cut and removed. This is necessary to fully treat the cancer, but causes breast numbness, which can be distressing.
Thankfully, a new technique has emerged in the fields of breast and plastic surgery to address the issue of breast and nipple loss of sensation after mastectomy. The procedure is termed a nerve-sparing mastectomy with nipple neurotization. During the surgery, the breast cancer surgeon performs an anatomic mastectomy preserving as many of the nerves supplying sensation to the breast skin as he or she can do safely. After the breast tissue is removed, the breast and plastic surgeon together identify and preserve one of the main nerves supplying sensation to the nipple. The plastic surgeon then uses a nerve graft to connect this nerve to another nerve or the skin underneath your nipple. This is done using tiny sutures or stiches about the size of a human hair under microscopic visualization.
Over the past 2 years, breast surgeon Michael Peyser MD and plastic surgeon Jordan Frey MD have brought this new and innovative technique to Buffalo, performing the first such procedures in Western New York. Since that time, they have been able to perform this nerve preserving procedure to many patients, offering a chance for a truly functional breast reconstruction and return to normalcy after breast cancer. While it does take 6-12 months for sensation to return, and it may never return to normal, results have been very promising. Even better, this nerve reconstruction does not add any recovery time to the procedure.
As this procedure continues to evolve, Drs. Peyser and Frey are eager to expand who is a candidate to receive a nerve-sparing mastectomy with neurotization. Having met with the select surgeons from around the country performing this operation, they are strong advocates for continually improving patient and surgeon education and shared decision making to make sure each patient has the best result possible.
If you are interested in learning more about nerve-sparing mastectomy with nipple neurotization, please call ECMC at 716-898-3073.
Dr. Jordan Frey is a plastic surgeon in the Center for Cancer Care, Department of Head and Neck Surgery and Plastic and Reconstructive Surgery at ECMC.