Nipple and Areola Preserving Mastectomies

This is Weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome. I'm Deborah Howell, and you know, oncoplastic procedures have really taken off, specifically nipple and areola-preserving mastectomies. Today, we're going to find out about the benefits of nipple and areola-preserving mastectomies, and learn which candidates are ideal for these procedures.

Our guest is Dr. Amy Bremner, a breast oncology surgeon at Memorial Care Medical Group in Laguna Hills, and Medical Director for Breast Surgical Oncology at Memorial Care Saddleback Medical Center. Welcome, Dr. Bremner.

Dr Amy Bremner: Thank you so much. Thanks for having me.

Deborah Howell (Host): Lovely. Lovely to have you. I'm going to dive right in if that's okay.

Dr Amy Bremner: Sounds good.

Deborah Howell (Host): A lot of women are familiar with breast surgery, like mastectomies after breast cancer. But how would you describe oncoplasty and how is it different from a standard breast surgery?

Dr Amy Bremner: So, oncoplastic surgery began really as a way to achieve better aesthetic and quality of life outcomes compared to traditional approaches with less side effects. And really what it's become is the use of an aesthetic approach to breast conservation or mastectomy that really enhances the range of options that can be offered to women with breast cancer and facilitates better outcomes from it. So, couple different things, better cosmetic outcomes as well as better oncologic outcomes, which is great. And it's really, you know, different than standard breast surgery and that it combines oncologic surgery, but using plastic surgery techniques.

One other thing, we want to really be thoughtful of how relieving women to live the rest of their lives, and our thought about aesthetics and good outcomes should be an integral part of the treatment for breast cancer.

Deborah Howell (Host): Absolutely. And what does the onco stand for?

Dr Amy Bremner: Cancer, essentially.

Deborah Howell (Host): Okay. All right. And what are some examples of oncoplasty procedures?

Dr Amy Bremner: So, oncoplastic breast procedures can refer to both breast-conserving surgeries, which would include lumpectomies or partial mastectomies, but it also refers to mastectomy procedures. And I know we're talking more about mastectomy procedures here, but examples of breast-conserving oncoplastic surgeries such as breast reductions for breast cancer, and then doing a breast reduction on the contralateral or opposite side for symmetry purposes. For smaller breasts, we can do lifts of the breast and also lifts on the other side for symmetries. So, you're actually getting the benefit of both breasts looking the same and looking even nicer.

And then with mastectomy procedures, it's actually more of a difficult skill to acquire than many assume. And there's a variety of mastectomy techniques that we can use, which can include low-lying scars; flat surfaces, some women prefer to go flat after a mastectomy; avoiding extra skin at the sides of the incisions, which is very important. And then of course, the different skin and nipple-sparing techniques. So, that's pretty much what we're talking about when we're talking about oncoplastic breast surgery.

Deborah Howell (Host): It really does sound like you have your women patients in mind for the rest of their lives.

Dr Amy Bremner: Yeah, very important. Because many and most women survive breast cancer, and you want them to feel good about themselves as they go about their life.

Deborah Howell (Host): Right. And getting more specific, what are nipple and areola-sparing mastectomies?

Dr Amy Bremner: So, essentially with a mastectomy, a standard mastectomy is where we would always remove the nipple and the areola, leaving a scar at the center of the breast and removing the underlying breast tissue. But with nipple and areola-sparing mastectomies, we actually remove the breast tissue from underneath the nipple, the areola, and the breast skin. So, what you're leaving is a skin envelope with an intact nipple and areola.

Deborah Howell (Host): So, what are some of the benefits of nipple and areola-preserving mastectomies?

Dr Amy Bremner: So, the main benefit of a nipple and areola-preserving mastectomy is really to provide good cosmetic results. And what leaving the nipple and the areola does is it leads to a more natural-appearing reconstruction rather than removing the nipple and the areola and then needing to reconstruct that at a later time. So essentially, just leaving the woman feeling like they have a little bit of themselves left and also makes the reconstruction look just a little bit more natural.

Deborah Howell (Host): Sure. And I'm sure that's very, very important to many women, right?

Dr Amy Bremner: Exactly. Definitely.

Deborah Howell (Host): And who's a good candidate for these oncoplastic procedures?

Dr Amy Bremner: It's interesting. It used to be very, very restrictive on who we thought we could do nipple-sparing mastectomies on. And actually now, it's becoming more of who isn't a good candidate nipple-sparing mastectomies. So when we used to think about this, who were candidates who were not, it was mainly patients who were not candidates, which are patients who have cancer in multiple areas within the breast, patients who have a very large tumor or patients who have cancer very close to their nipple. And it used to be a cutoff of being about two centimeters away.

The good news is that now we're noticing that we don't actually have to limit ourselves to some of these restrictions. And a lot of women are good candidates and we have many different ways of helping them to get to that point, whether it be a two-stage process or even a three-stage process. But we look at, or I look at, all of my patients when they come in that are wanting mastectomies or needing mastectomies as a possible nipple-sparing candidate.

Deborah Howell (Host): Now, Dr. Bremner, for women who have gone through the procedure, what have their thoughts been on the results?

Dr Amy Bremner: Overall very, very positive. As far as their results go, they do feel that they have preserved some of their own natural anatomy. A reconstructive breast definitely looks different than, say, an augmented breast or their natural breast, but preserving that piece of them makes them feel a little more connected to themselves rather than having these kind of foreign bodies on their chest. With nipple-sparing mastectomies, they don't necessarily maintain sensation in the nipples, but it's more of a cosmetic look and a more natural look.

Deborah Howell (Host): So, I'm sure this is why more women are opting for nipple-sparing mastectomies.

Dr Amy Bremner: Yeah, exactly. I think when they either come in knowing about the procedure and knowing that that's an option, they're clearly asking about that option. And when they uncover that, yes, they potentially could save their nipples, most of the women do prefer to do that, and again, mostly for the more natural appearance and feeling more a part of themselves.

Deborah Howell (Host): What's the recovery time like?

Dr Amy Bremner: The recovery time for a nipple and areola-sparing mastectomy is essentially the same as a traditional skin-sparing mastectomy. And depending on the patient, usually anywhere from four to six weeks. And that's, of course, assuming they're doing reconstruction. So, it can vary a bit here and there. But mostly, we say about a four-week range to where they're feeling kind of back to normal, back to their normal activities, that kind of thing.

Deborah Howell (Host): Everybody wants to know how long before I can drive.

Dr Amy Bremner: Good question. So mostly, we say, well, at minimum a week. I wait until I see my patients their first postop visit after one week and see how they're doing, assess their pain, their functionality. And then, of course, no driving while you're taking pain medication. And also, we advise not to drive while you have drains present after surgery. You really want to have a good reaction time and you don't want to be worried about driving in those conditions. But mostly, I would say there's no standard answers as far as exactly when you can get back to driving. But at minimum, most likely two weeks. But we kind of evaluate on a case by case basis.

Deborah Howell (Host): And is there any physical therapy involved?

Dr Amy Bremner: Yeah. Actually, we have a great physical therapy department here at Memorial Care, and they actually prefer that we send our patients right when they're newly diagnosed to get them set up in the system. And if not, when they're newly diagnosed after their surgery, we send them there. They prefer that we send all of our patients there. Some patients don't prefer to go. Others prefer to go if they're having any kind of limited range of motion say, or tightness in their chest. But yes, very great option for all patients actually undergoing any type of breast surgery to be tied in with the physical therapy department just to help with exercises, preventative measures, things like that.

Deborah Howell (Host): And what not to do, what not to lift and all that.

Dr Amy Bremner: Yes, of course.

Deborah Howell (Host): So, where can people go if they want to learn more or to schedule an appointment?

Dr Amy Bremner: Well, sure, yeah, if they'd like to learn more, they can definitely go to memorialcare.org/breastcare and they can check out our website. Or if they'd like to make an appointment, I can be reached at my office at 657-241-9660 and we'd be happy to make an appointment to discuss all options.

Deborah Howell (Host): And you're in Laguna Hills, correct?

Dr Amy Bremner: Yes.

Deborah Howell (Host): That's 657-241-9660. Thank you so much, Dr. Bremner, for your time and your expertise today. Is there anything else you'd like to add to our conversation?

Dr Amy Bremner: I think we got all the information out there and hoping to talk to more women about the procedure.

Deborah Howell (Host): Wonderful. And we really enjoyed having you on the show.

Dr Amy Bremner: Thank you so much.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.