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Nipple-Sparing Mastectomy Offers Safe, More Natural Option for Women with High Breast Cancer Risk

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Alissa Shulman, MD, and Russell Novak, MDSARASOTA (July 16, 2014) – Breasts certainly don’t define a woman, but the prospect of surgically removing them to reduce your cancer risk can shake even the strongest resolve.

Today, however, the promise of a new skin- and nipple-sparing approach to mastectomy is making that life-altering decision a little easier for some women. 

“From a psychological standpoint, being able to save that part of my breast was huge,” said Lynn Zook, 49, who was diagnosed with breast cancer earlier this year and opted for a new skin- and nipple-sparing technique offered by Sarasota Memorial breast cancer surgery and reconstruction specialists Russell Novak, MD, and Alissa Shulman, MD. 

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“The thought of losing everything – on top of dealing with the cancer – would have been very hard to bear,” Zook said. “I knew I had to put myself in the best possible position to survive this – both physically and mentally – and I felt this new approach was my best option.”

Typically, treatments like these are available only at highly specialized cancer centers, or academic medical centers. But more women are exploring the option after superstar Angelina Jolie publicized details of her bilateral nipple-sparing mastectomy last year. 


Janet Crosby

Lynn Zook

“It’s still considered a novel approach, but we’re excited to be able to offer it at Sarasota Memorial,” said GYN Oncologist James Fiorica, MD, medical director of Sarasota Memorial’s Women’s Cancer Program. “Previous studies have shown this treatment to be a promising new option for women. As the quality of life benefits become clear, it may become the new standard of care for women with certain breast cancers in the future.”

Novak, a board certified general surgeon, and Shulman, a board certified plastic surgeon, have more than 40 years combined experience in breast cancer surgery and reconstruction. They recently teamed up to perform nipple-sparing mastectomies at Sarasota Memorial, as a treatment for women newly diagnosed with certain breast cancers, as well as a prophylactic, or preventive measure for those at high risk of developing it.

The National Comprehensive Cancer Network guidelines recommend women like 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.

Until recently, women undergoing mastectomies were left with a less-than-natural-looking appearance, even with the best reconstruction efforts, said Shulman. “With the nipple-sparing approach, they can reduce their cancer risk by as much as 95% and still be left with naturally appearing breasts,” she said.

In a traditional mastectomy, surgeons remove the entire breast – breast tissue, skin, nipple and areola (the dark skin surrounding the nipple). The nipple-sparing approach removes the patient’s underlying breast tissue but preserves the nipple-areola complex and most of the breast skin. 

Not every woman who needs a mastectomy is a good candidate for the surgery. It depends on several factors, including the size of the cancer, the size of the breast and the location of the cancer within the breast, Novak said.

“Our highest priority is making sure the breast is completely cancer free,” Novak said. “But for those women who meet the criteria – those with tumors that are not near the nipple area or those whose genetic testing reveals are at high risk – it is a viable option.”

As with any surgery, there are risks. While the breast looks virtually unchanged – there is only a small scar hidden beneath the breast – preserving feeling isn't always possible, Novak said. Other risks include loss of the nipple if it does not continue to get an adequate blood supply. 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. 

Janet Cosby recently had two lumpectomies in her right breast at a specialized cancer center in the region. Those surgeries did not result in clear margins, meaning cancerous tissue could still be hidden in her breast tissue. Although further treatment was not immediately recommended, the Sarasota mother and grandmother did not want to wait and worry. She decided to reduce her risk with a bilateral mastectomy – and also chose the nipple-sparing approach offered at Sarasota Memorial.

“I knew I was not in trouble like someone with stage 4 cancer, but I also knew I had a compromised immune system and did not feel it was safe to wait,” Cosby said. ““In the end, I’m so glad I had it done, because they found invasive cancer in my other breast.”


About Sarasota Memorial Health Care System: Sarasota Memorial Health Care System is a regional referral center offering Southwest Florida’s greatest breadth and depth of inpatient, outpatient and extended care services, with more than 800 physicians, 4,000 employees and 800,000 patient visits a year. Sarasota Memorial’s 806-bed acute care hospital has been recognized repeatedly as one of the nation’s best, with superior patient outcomes and a complete continuum of outpatient services– from urgent care centers and physician groups, to laboratory and imaging centers, home health, rehabilitation and long-term care.

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