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Published on November 12, 2013

Angelina Jolie Nipple-Sparing Mastectomy: the Latest Development in Breast Cancer Treatment and Prevention, Available at UHS Breast Center

UHS News Release

Release: Immediately

Contact: Jon Tooley, 607.762.2425 or jon_tooley@uhs.org

November 12, 2013

Earlier this year, a relatively new mastectomy procedure captured the world’s attention when actress, director, screenwriter and humanitarian Angelina Jolie revealed she had undergone a bilateral nipple-sparing mastectomy to reduce her risk of developing breast cancer. As a carrier of the BRCA 1 genetic mutation, Jolie’s likelihood of developing breast cancer was significantly greater than normal.

According to Camelia Lawrence, MD, FACS, a board-certified, fellowship-trained breast surgeon on staff at the UHS Breast Center, “The nipple-sparing mastectomy entails the removal of the patient’s breast tissue while preserving her skin, nipple and areola (the dark skin surrounding the nipple). All the underlying breast tissue is removed; what remains is the skin envelope along with the nipple-areola complex.”

The procedure can be performed on women who undergo breast removal as part of their cancer treatment, as well as on those who choose prophylactic (preventive) mastectomies as a result of genetic mutations and other factors that put them at substantially greater than normal risk for breast cancer.

However, Dr. Lawrence cautions, “It is not a procedure for all women at high risk, nor is it a procedure for all women with breast cancer. There are definite criteria for patient selection that need to be met.”

Traditionally, mastectomy was performed by removing the breast tissue, skin and nipple-areola complex. This often resulted in a less-than-natural-looking appearance, even with the best reconstruction efforts. Because of this, many women who had these mastectomies elected not to undergo reconstruction. “In contrast,” explains Dr. Lawrence, “with nipple-sparing mastectomy we leave the skin envelope and nipple-areola complex, so the patient is able to get a reconstructed breast that appears quite similar to what she had before the surgery.”

She continues, “This is a very attractive procedure for women who are at high risk for breast cancer. The NCCN [National Comprehensive Cancer Network] guidelines recommend women like Angelina Jolie who test positive for the BRCA 1 or BRCA 2 genetic mutations undergo risk-reducing mastectomy as well as oophorectomy [removal of the ovaries].” Many of these women will be good candidates for nipple-sparing mastectomy, Dr. Lawrence notes, “which substantially reduces their risk of breast cancer by 95 to 98 percent while leaving them with naturally appearing breasts.”

As in Jolie’s case, most people can’t tell the patient has had the surgery unless she chooses to divulge that information. “That’s the whole concept behind the nipple-sparing mastectomy: it offers patients a better cosmetic outcome,” says Dr. Lawrence. “However, I want to stress that while the cosmetic outcome is high on the priority list, the oncologic reason behind the surgery takes precedence.”

Surgeons consider several factors in determining if a woman is a good candidate for this procedure. If the patient is choosing the surgery for breast cancer treatment, her surgeon will consider the size and location of the tumor and whether or not the cancer has spread to the skin. The type of breast cancer is another factor. “There are some cancers where you wouldn’t consider this procedure,” explains Dr. Lawrence. “For example, a patient with inflammatory breast cancer isn’t a candidate for nipple-sparing mastectomy. But, the majority of types of breast cancer aren’t exclusionary for this surgery.”

For both high-risk and breast cancer patients, the size of the woman’s breasts also makes a difference. In large-breasted women who have a significant amount of drooping, there is concern about having sufficient blood supply to the nipple-areola complex.

Most patients having nipple-sparing mastectomy experience a significant reduction or the complete elimination of sensation in the nipple; that loss is permanent. In addition, there are other risks. Patients choosing nipple-sparing mastectomy for risk reduction or breast cancer treatment face the risk of nipple loss, which can occur if the nipple doesn’t continue to get an adequate blood supply and nipple necrosis results. Women who have breast cancer also face the risk of “positive nipple,” which means the surgeon discovers cancer cells in the nipple during the surgery (a nipple biopsy is performed as part of the procedure). If cancer cells are found, the surgeon must remove the nipple.

“The risks involved with nipple-sparing mastectomy are why the patient’s choice of surgeon is so important,” says Dr. Lawrence. “You want to choose a breast surgeon who performs the procedure on a regular basis because it’s critical that all the breast tissue is removed — or as much as possible — and that a nipple biopsy is performed at the time of the surgery.”

Dr. Lawrence gained her experience with the procedure through her fellowship. “I completed a dedicated breast surgery fellowship at the John Wayne Cancer Institute in Santa Monica, California. There, I dealt with a lot of patients who were choosing risk-reduction mastectomy or were undergoing mastectomy because of breast cancer and they all wanted the best cosmetic outcome.”

When Dr. Lawrence joined the UHS Breast Center in 2011, the center applied for and was approved to participate in the American Society of Breast Surgeons Nipple-Sparing Mastectomy Registry. “This allows me to offer those services locally, and we’ve performed a number of nipple-sparing mastectomies here with terrific outcomes,” she says.

Women interested in learning more about nipple-sparing mastectomy who are at high risk for breast cancer or who have breast cancer should see a breast surgeon to discuss their case and whether or not this surgery is the right one for them. Also, men and women with any breast concerns or questions are encouraged to contact the UHS Breast Center at (607) 763-5523.

UHS is a locally owned, not-for-profit, 916-bed hospital and healthcare system serving Greater Binghamton and surrounding counties. Founded in 1981, UHS provides a full range of medical, surgical, rehabilitative and long-term care services from more than 60 locations around New York’s Southern Tier.
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