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The nipple sparing mastectomy followed by reconstruction offers the best appearing breast after removal of breast glandular tissue (mastectomy). Subsequent reconstruction utilizes a submuscular breast implant. Without question, it is the most natural of all breast reconstructive procedures; however since the nipple is spared, there still remains a tiny amount of breast tissue at risk. The ever popular breast preserving lumpectomy (and radiation) leaves the majority of the breast glandular tissue; whereas the nipple sparing mastectomy removes 90% of the breast gland (prpjected 90% risk reduction). The breast tissue remaining is directly beneath the nipple, and should a tumor develop there it should be easily felt. The small disc of tissue beneath the nipple allows for nipple blood supply to the nipple at the time of surgery (mastectomy). Indications for this operation include patients of high cancer risk (documented), severe unremitting breast glandular pain (mastodynia) which cannot be controlled medically; and certain forms of breast cancer. It must be remembered that this is NOT a 100% mastectomy; it is a 90% mastectomy. By comparison, a lumpectomy leaves 90% of breast tissue. The nipple sparing mastectomy does not include the potential ill effects of radiation.  If preserving the appearance of your breast is important to you, and you have a high risk of breast cancer and would like removal of your breast glandular tissue to prevent cancer (prophylaxis), this operation is important for you to consider. Although not defined as “cosmetic surgery”, the results are nevertheless highly acceptable when performed in the optimal manner. For the best results two stages are required. After removal of the breast glandular tissue, the skin and subcutaneous tissue must adhere to the muscular chest wall and retract. Four months later an implant is placed beneath the chest wall muscle. The muscle provides the necessary soft tissue coverage over the implant. Optimal results can be anticipated thereafter.   | |||||