Mastectomy Options

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Aesthetic Flat Closure
Mastectomy performed with deliberate attention to producing a smooth, well-contoured chest wall without surgical reconstruction. This is not simply "not having reconstruction." It is a surgical approach in its own right, planned from the beginning with the flat result in mind. Excess skin is removed carefully, closure is performed in layers, and the goal is a chest wall that is comfortable, smooth, and livable. Many women who choose flat closure describe the result as freeing — a body that feels chosen rather than compromised. All future reconstructive options remain available. A patient who chooses flat closure today can pursue reconstruction at any point in the future.

Skin-Sparing Mastectomy
Removes all breast tissue including the nipple-areolar complex while preserving as much of the breast skin envelope as possible. The preserved skin creates a natural pocket for immediate reconstruction, significantly improving the reconstructive result compared to traditional mastectomy. Skin-sparing mastectomy is the standard approach when the nipple cannot be preserved either due to tumor location, margin distance, or other oncologic factors, but the patient wishes to pursue reconstruction.

Nipple-Sparing Mastectomy (NSM)
Removes all breast tissue while preserving the nipple-areolar complex in addition to the breast skin envelope. When oncologically appropriate and technically feasible, nipple-sparing mastectomy produces the most natural reconstructive result — the breast looks and, to the extent possible, feels more like the patient's own breast. NSM requires that the tissue directly behind the nipple be confirmed cancer-free either pre-operatively or intraoperatively.

Mastectomy regardless of type severs the nerves that supply sensation to the breast and nipple. Most patients who undergo nipple-sparing mastectomy experience significantly reduced or complete loss of nipple sensation. The nipple looks normal. In most cases it does not feel normal at least not initially, and often not fully, even long-term.

Some sensation recovery is possible over time as nerves regenerate, and surgical techniques to preserve or reconnect nerve supply are an evolving area of breast surgery. But the expectation going into surgery should be honest: nipple-sparing mastectomy is primarily an aesthetic decision. Sensation is a separate outcome that should be discussed realistically, not assumed.

Aesthetic flat closure may be right if:

• You do not wish to pursue reconstruction — now or in the foreseeable future
• You want to minimize surgical complexity and long-term implant maintenance
• You feel whole without a reconstructed breast and want a chest wall that reflects that choice
• You are not medically a good candidate for reconstruction
• You want time before deciding - flat closure now, reconstruction later if desired

Skin-sparing mastectomy may be right if:

• You want reconstruction but are not a candidate for nipple-sparing mastectomy
• The tumor is close to or involves the nipple-areolar complex
• Breast anatomy makes nipple viability uncertain
• You want to preserve the skin envelope for the best possible reconstructive foundation

Nipple-sparing mastectomy may be right if:

• The tumor is at least 2cm from the nipple-areolar complex
• Pre-operative imaging shows no retroareolar involvement
• Breast anatomy supports nipple viability after mastectomy
• You are undergoing prophylactic mastectomy for BRCA or high genetic risk
• You want the most natural reconstructive result possible