What is a Nipple-Sparing Mastectomy?

 

A nipple-sparing mastectomy removes all the breast glandular tissue through a small incision while preserving the nipple–areola complex and the surrounding skin.

​

This technique allows a natural breast appearance after reconstruction, while maintaining oncological safety when the cancer is not close to the nipple.

 

It can be performed for:

​

• Early-stage breast cancer without nipple involvement

• Genetic mutation carriers (e.g. BRCA1 or BRCA2) seeking preventive surgery

• Selected cases of DCIS or multifocal disease where nipple preservation is safe

 

If the final pathology later shows cancer cells close to or behind the nipple, the nipple may need to be removed in a secondary procedure for safety.

​

Before the Procedure

​

• You will meet your surgeon and anaesthetist on the day of surgery to review your plan and ask any questions.

• Bring your breast imaging and reports if they were performed outside the hospital.

• The surgical plan, including lymph node surgery and reconstruction details, will be confirmed.

• You’ll arrive fasting as instructed, and the incision sites will be marked before going to the theatre.

​​

During the Procedure

 

• The surgery is performed under general anaesthetic, so you will be asleep throughout.

• A small incision — usually along the inframammary fold (under the breast) or lateral chest crease — is used to remove the breast tissue from beneath the preserved nipple and skin.

• If indicated, a sentinel lymph node biopsy or axillary lymph node dissection will be performed through the same or a nearby incision.

• Immediate reconstruction is performed using an implant, tissue expander, or autologous tissue(flap).

• The reconstruction restores the breast’s natural shape and contour in the same operation.

• One small drain is placed to remove fluid and reduce swelling.

• The incision is closed with dissolvable sutures and sealed with surgical glue or steri-strips.

• A light protective dressing is applied — no bra is worn immediately after surgery to avoid pressure on the nipple.

• The operation generally takes 1-2hours, depending on whether reconstruction or lymph node surgery is performed.

• Most patients stay in the hospital for one to two nights.

​

After the Procedure

​

• You’ll wake up in the recovery area before being transferred to the ward.

• Nursing staff will monitor your comfort, wound sites, and nipple perfusion.

• The drains usually remain for a few days and are removed when drainage is minimal.

• You surgical bra will be worn from the day after surgery, once we confirms that nipple perfusion is satisfactory.

• The bra should then be worn day and night for at least two weeks to provide support and reduce swelling.

• Your dressing is waterproof, and you can shower from the day after surgery.

• You’ll be encouraged to perform gentle arm and shoulder exercises to maintain mobility.

• Driving is permitted after your first postoperative review, once movement is comfortable and you are off strong pain medication.

 

Pathology results are usually ready within 7–10 days and will be discussed at your follow-up visit.

If further treatment is required, such as radiotherapy or hormone therapy, it will be planned once you have recovered.

Possible Risks and Side Effects

 

Although nipple-sparing mastectomy is generally safe, possible risks include but not limitted to:

​

• Bleeding or haematoma

• Infection

• Fluid collection (seroma)

• Partial or complete nipple or skin flap necrosis if blood flow is reduced

• Delayed wound healing

• Changes in nipple sensation

• Implant-related complications (if reconstruction performed)

• Shoulder stiffness or tightness

​

Benefits of Nipple-Sparing Mastectomy

​

• Preserves the nipple and skin, maintaining a more natural breast appearance

• Allows immediate reconstruction in the same operation

• Oncologically safe in properly selected patients

• Faster recovery and improved body image outcomes

​

Key Points

• Removes lamost all breast tissue while preserving the nipple and skin

• Often combined with immediate reconstruction

• No bra worn immediately after surgery — surgical bra fitted from day one post-op after nipple perfusion is checked

• You can shower from the day after surgery

• Wear the surgical bra continuously for at least two weeks once applied

• Driving permitted after your first postoperative review

• Typical hospital stay: one to two nights, with small drains in place for a few days