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Nipple-Sparing Mastectomy Surgery

What is a Nipple-Sparing Mastectomy Surgery?

A nipple-sparing mastectomy is a type of breast cancer surgery that removes the breast tissue while preserving the natural skin, nipple, and areola. This approach allows for a more natural-looking breast after reconstruction, offering emotional and cosmetic benefits for many patients. 

Unlike a traditional mastectomy, which removes the nipple and often results in more visible scarring, a nipple-sparing mastectomy maintains the outward appearance of the breast while still treating the underlying disease.

Nipple-sparing mastectomy is often recommended when the cancer is small and located away from the nipple, or when the procedure is preventative (prophylactic) for patients at a high genetic risk. Because safety is always the priority, your surgical team will determine if this approach is right for you.  

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Key Information

  • Nipple-sparing mastectomy (NSM) is the latest evolution in mastectomy technique
  • Preserves the nipple and areola, offering the most natural post-op breast appearance
  • Often results in higher patient satisfaction with cosmetic outcomes compared to traditional or completion mastectomies
  • Can be safely combined with natural tissue or implant-based reconstruction
  • Ideal for smaller tumors located away from the nipple and for prophylactic mastectomies in high-risk patients
  • Can incorporate hidden scar techniques
  • Does not compromise cancer treatment when performed in appropriate candidates
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What to Expect During Surgery

During a nipple-sparing mastectomy, your surgeon carefully removes the breast tissue through a small, strategically placed incision. In many cases, this incision is positioned along the natural fold beneath the breast or around the areola, allowing the nipple, areola, and outer breast skin to be preserved. When appropriate, hidden scar techniques may be used to place the incision in a less visible area, helping minimize long-term scarring while maintaining oncologic safety.

To ensure the procedure is safe, your surgeon will take a small sample of tissue from beneath the nipple during surgery and evaluate it for cancer (called an intraoperative biopsy). If cancer cells are detected at that time, the nipple and areola must be removed to ensure the disease is fully treated.

The goal of a nipple-sparing mastectomy is to treat or prevent breast cancer while preserving as much of the natural breast appearance as possible. When combined with reconstruction, this approach supports both physical healing and emotional well-being.

A nipple-sparing mastectomy with reconstruction typically takes between 3 and 6 hours, depending on the type of reconstruction performed.

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Before & After

See real results from women who’ve trusted PRMA with their reconstruction journey.
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Recovery Timeline

  • Week 1:
    You’ll likely feel sore, swollen, and fatigued, especially around the chest and incision area. During this time, rest is essential, and most pain can be managed with medication. 
  • Weeks 2:
    Swelling begins to improve, and many patients feel more mobile. You may begin light activity as your care team advises, but upper body restrictions remain important for proper healing.
  • Weeks 3:
    By the third week, discomfort continues to decrease, and energy levels often begin to return. Your surgeon may also clear you for short walks and more independent daily tasks. 
  • Weeks 4 and Beyond:
    By this time, scars will continue to fade and most patients return to many normal routines, though full activity clearance—like exercise or lifting—typically happens around 6–8 weeks.

Who is a Candidate for a Nipple-Sparing Mastectomy?

Not everyone is eligible for a nipple-sparing mastectomy, but for many women, it can be a safe and effective option that preserves the natural look of the breast. Eligibility depends on factors like tumor location, breast size, nipple position, and overall health.

You may be a strong candidate for a nipple-sparing mastectomy if:

  • Your tumor is small and not located near the nipple
  • There is no cancer involvement in the nipple or areola
  • You're undergoing a preventive mastectomy due to high genetic risk (like BRCA)
  • You’re in good overall health and a non-smoker (or able to quit for several weeks before surgery)
  • Your breast size and shape allow for safe preservation of the nipple
  • You’re seeking a more natural aesthetic outcome with reconstruction
  • You are not seeking a significant breast lift, as this may affect the nipple's long-term preservation and blood flow
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Find Your Surgeon

PRMA is the only center in San Antonio, Texas, and one of the few centers worldwide that offers breast reconstruction on such a large scale. Discover why thousands of women travel from across Texas, the US, and the world for their breast reconstruction surgery. We are proud to have a tremendous global reputation for surgical excellence.
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Dr. Minas Chrysopoulo
Championing Advanced Breast Reconstruction Access Nationwide
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Dr. Gary Arishita
Dedicated to Restoring Confidence Through Expert Reconstruction
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Dr. Oscar Ochoa
Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)
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Dr. Gary Arishita
Dedicated to Restoring Confidence Through Expert Reconstruction
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Dr. Oscar Ochoa
Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)

Will Insurance Cover a Nipple-Sparing Mastectomy Surgery?

Most insurance plans do cover nipple-sparing mastectomies when they are part of breast cancer treatment or preventive care for high-risk patients. Federal law requires coverage for mastectomy procedures and any related reconstruction, including techniques that preserve the nipple. 

At PRMA, we work closely with your insurance provider to ensure coverage is clearly understood and your care is as stress-free as possible. You deserve access to the treatment that’s right for you, and we’re here to help make that happen.

For more information, visit Insurance FAQs in the patient resource center.

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Preparing for Abdominal Flap Reconstruction Surgery

Many of our patients travel in from all parts of the country for breast cancer surgery and reconstruction procedures. To help you prepare, our team will walk you through every step, from pre-op planning to travel arrangements, to ensure a smooth and supported experience.

Learn more about:
Preparing for Surgery
Travel Accomodations

Frequently Asked Questions

Is there a risk that the preserved nipple won't survive after surgery?
Yes, there is a small risk of nipple tissue loss (called necrosis), especially if blood flow to the area is compromised during the mastectomy. 
Will I still need radiation or chemotherapy after a mastectomy?
Possibly. A mastectomy removes breast tissue, but additional treatments like radiation or chemotherapy may still be recommended based on your cancer’s stage, type, and whether it has spread to lymph nodes. 
Can both breasts be done at the same time, even if only one has cancer?
Yes. Many patients choose to undergo a bilateral mastectomy, removing both breasts, either for symmetry during reconstruction or due to a high genetic risk. 
Will I need to wear a surgical bra or compression garment after surgery?
Yes. Most patients are advised to wear a post-surgical bra or compression garment for several weeks to reduce swelling and support healing. Our dedicated team will guide you through every step of your surgical care.

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