Nipple-sparing mastectomy (NSM) is offering new options for women facing breast cancer surgery. Unlike traditional mastectomy, NSM preserves the skin, nipple, and areola while removing breast tissue. This approach can help maintain a more natural appearance after reconstruction.
“Because the skin envelope and nipple–areola complex remain intact, the breast retains a more natural shape and appearance compared to traditional mastectomy,” said Susan Kesmodel, M.D., director of breast surgical oncology and co-leader of the Breast Site Disease Group at Sylvester Comprehensive Cancer Center, part of UHealth – University of Miami Health System. “The external appearance can often look nearly indistinguishable from a natural breast—sometimes almost identical in clothes or at a glance.”
Dr. Kesmodel noted that the benefits go beyond aesthetics: “NSM can ease the psychological and emotional burden of a cancer diagnosis, helping patients maintain a stronger sense of body image and sexual well-being after surgery.”
Lourdes Milian underwent NSM after being diagnosed with stage 0 ductal carcinoma in situ (DCIS) at age 41 during a routine mammogram. She chose double mastectomy with NSM following discussions with her care team. “My team explained every option, but I knew the final choice had to be mine,” Milian said. “I made my decision and never looked back.”
Milian’s goal was to preserve her chest’s natural appearance despite her tumor’s proximity to her nipple. She said, “I wanted to look and feel like myself again, without the constant visual reminder of cancer.” After surgery, she has remained cancer-free for three years.
NSM is most suitable for patients whose tumors are not close to or involving the nipple–areola complex and who have favorable anatomy such as small-to-moderate breast size and minimal drooping. It may also be considered for those undergoing risk-reducing mastectomy due to genetic factors such as BRCA mutations.
Patients are not candidates if their tumors involve or are near the nipple–areola complex or if they have locally advanced or inflammatory breast cancer. Those who have had prior radiation therapy or who smoke may face higher risks from this procedure.
Dr. Kesmodel emphasized that treatment decisions should be made after consultation with all members of the care team.
At Sylvester Comprehensive Cancer Center, Dr. Kesmodel works alongside specialists including plastic surgeon Devinder Singh, M.D., chief and program director of the Division of Plastic Surgery, and oncologist Frances Valdes, M.D., assistant professor of clinical medicine. The multidisciplinary team aims to provide comprehensive care that addresses both medical needs and quality-of-life considerations.
Sylvester is also involved in clinical research on NSM techniques designed to preserve sensation and minimize trauma during surgery.
