Angelina Jolie recently shared her BRCA+ diagnosis and brave decision to undergo prophylactic nipple-sparing mastectomy and immediate breast reconstruction. As part of her surgery, she underwent a nipple delay procedure.
So what is a "nipple delay"?
Most patients do not need a delay procedure. It's actually performed quite rarely. It can however be a good option for patients who want nipple-sparing mastectomy but are at high risk for nipple necrosis. High risk patients include smokers, patients with moderate to significant breast ptosis (sagging), and patients with a history of previous breast surgery (eg breast reduction or lift).
Nipple delay is usually performed 7-21 days before the nipple-sparing mastectomy. The nipple-areolar complex and a rim of surrounding breast skin is elevated off the underlying breast gland. This disconnects all the ducts connecting the breast tissue to the nipple and also cuts off the blood supply to the nipple and areola from the underlying breast tissue. At this point, the nipple-areolar complex is only kept alive by the blood supply from the surrounding skin.
Over the next 1 - 3 weeks, this remaining blood supply becomes much more robust and the blood flow to the nipple-areola from the surrounding skin increases. This improved blood supply makes the subsequent nipple-sparing mastectomy safer and decreases the risk of nipple-areolar necrosis (tissue death) and wound healing complications.
The procedure is combined with a subareolar biopsy to ensure there are no cancer cells involving the nipple-areolar complex. If the subareolar biopsy reveals malignancy, the nipple and areoala are removed at the time of mastectomy. Sentinel lymph node biopsy is also usually performed at the same time as the nipple delay procedure if it is indicated.
Nipple delay does not decrease the risk of future breast cancer. As long as the subareolar biopsy is negative, the risk of future breast cancer is very low and is the same as with standard nipple-sparing mastectomy .
Nipple delay is usually covered by insurance if it is medically justified and the mastectomy is covered.