Nipple Delay Surgical Procedure for Breast Reconstruction

Nipple delay is a surgical procedure done in preparation for a nipple-sparing mastectomy. It's one of many nipple-sparing surgical techniques which can be done to preserve the nipple when the breast has to be removed due to cancer.

To find out whether it's safe for you to keep your nipple, your surgeon will perform a biopsy on tissue from beneath the nipple, to ensure no cancer cells remain behind in the breast.

This article will review the procedure, and what to expect if you and your surgeon decide this is the right procedure for you.

Purpose of Procedure

The nipple and areola complex (NAC) needs a dedicated supply of blood to be healthy. If there is not a great blood supply, the tissue can die and would need to be surgically removed.

Nipple delay is intended to create new blood vessels from the skin on the breast to the NAC that will keep the natural nipple and areola alive.

Benefits of Nipple Sparing

Keeping the natural nipple preserves the original look and feel of the breast without requiring nipple reconstruction. Some of the tactile sensations of a natural nipple may be preserved if some of the nerves stay connected. (A reconstructed nipple won't feel anything other than pressure.)

An additional benefit to a nipple-sparing mastectomy is that it can reduce some of the negative body image feelings and depression after having lost the breast. Studies have shown that the quality of life in women who have a nipple-sparing mastectomy is better than those who have a non-nipple-sparing mastectomy.

Women with BRCA gene mutations who choose prophylactic mastectomies are often considered good candidates for keeping their natural nipples.

Risks and Contraindications

In addition to the standard risks of surgery—anesthesia, pain, bleeding, and infection—the primary risk of nipple delay is the low risk of the nipple not surviving.

A study done at John Wayne Cancer Institute in Santa Monica, California, reported on results of nipple-sparing surgery performed on 99 women who were followed for five years. Researchers reported that 22 of the spared nipples were eventually lost to cancer; eight surgeries failed, and in two cases, women chose to later have their nipples removed.

Nipple delay isn't a good option for everyone. Those who are not considered good candidates include smokers (due to a restriction of blood flow that compromises the healing process) and those with:

• Tumors near the nipple
• Cancer found during the biopsy
• Skin that is affected by cancer
• Bloody nipple discharge

Before the Procedure

The facility where your procedure is being done may want you to come in for a pre-operative appointment to fill out paperwork and ask any questions you may have. If not, you'll need to be sure you arrive early enough the day of your procedure to take care of these things.

Timing

A nipple delay procedure is scheduled as outpatient surgery about two weeks before your mastectomy. It takes several hours to complete.

Location

This procedure is performed at hospitals and surgical centers.

What to Wear

You'll be in a hospital gown for the procedure. For the trip home, you'll want to have a supportive, soft-cup bra and a button-down shirt, so you won't risk straining the recovering area by raising your arms above your head.

Food and Drink

You'll need to avoid eating and drinking for 8-12 hours before your surgery.

Ask whether you'll need to be off of any medications or supplements for an extended period before surgery. If you can take medications the morning of your procedure, find out if you can do so with a little sip of water or not.

Cost and Health Insurance

As long as your health insurance plan will cover the cost of a mastectomy, by federal law it must also cover the cost of the reconstructive surgery as well. However, there may be some differences from state to state. Check with your insurance carrier for specifics on your insurance coverage.

If you have a copay, check with the facility where the procedure is being done to see when that will be due.

What to Bring

Make sure you have your insurance card, identification, and any paperwork the healthcare provider may have given you when you arrive for your procedure.

It's a good idea to have something to read or entertain yourself with. You may be there for a while before the surgery begins.

Other Considerations

You'll need to have someone drive you home, as it's not considered safe to drive within 24 hours of being under general anesthesia. Make sure to arrange for that ahead of time.

During the Procedure

You will interact with several members of the medical staff, as well as your surgeon.

Pre-Surgery

You'll have an intravenous (IV) tube placed in your hand to deliver fluids, anesthesia, and possibly medications. A nurse will check your vital signs and the anesthesiologist will likely talk to you about the anesthetic you'll receive and what to expect from it.

Your surgeon may also come in and review things with you. The breast to be operated on will be marked to make sure there's no error.

Throughout the Surgery

Once you're asleep, your surgeon will make an incision in your skin where your mastectomy scar will be located. This may be under your areola or in the crease beneath your breast.

About half of your breast skin will be lifted off of the fatty and glandular parts of your breast. This will disconnect the blood vessels that normally provide circulation to your nipple, which encourages new vessels to connect from the breast skin to your nipple-areola complex, thus keeping it alive.

Your surgeon will also take a biopsy of tissue from under your NAC and send it to the pathology lab.

Recovery

Once you're stitched up and bandaged, you'll be moved to a recovery room to come out from under the anesthesia. Once you're awake, as long as everything is going as planned, you'll be given follow-up care instructions and discharged.

After the Procedure

Ask your surgeon or the facility how long it will take to get your biopsy results back. These will tell you whether you can keep your nipple or if the nipple itself may be cancerous.

Managing Side Effects

You may have some discomfort and bruising during recovery from a nipple delay procedure. Some surgeons may have you massage a skin cream on your breast(s) to help stimulate blood flow.

If you need anti-nausea medications, be sure to take them exactly as prescribed—don’t wait until you feel sick, as these work best when taken preventatively. Take it easy until you feel your energy levels return to normal.

If you experience any unexpected or severe side effects from the surgery, call your healthcare provider.

Summary

A nipple delay surgery is done to help improve blood flow and circulation to the nipple in preparation for mastectomy. One of the risks of a nipple sparing mastectomy is that the NAC can lose some of the blood vessels that feed it, and when it loses blood supply the tissue dies.

The nipple delay surgery is done in the weeks leading up to the mastectomy, and separates the fatty and glandular tissue away from the NAC. A biopsy is also taken during this time from the area under the NAC to determine if any cancer cells are present there.

A Word From Verywell

Talk to your healthcare provider before the procedure about what the odds are that you'll be able to keep your natural nipples. Regardless of what part of your breast(s) you keep or lose, this process is about safeguarding your health and removing breast cancer. While you may experience things that can be emotionally and physically difficult, try to say focused on the goal, which is returning to good health.