Nip it in the bud
Dr Toogood describes how breast cancer can affect your nipples.
Most commonly patients tell me they first became aware of a potential problem with their breast health when they felt a painless lump in their breast tissue during self-examination. Another large group of women I treat received the dread diagnosis when a mass was discovered at a routine annual mammogram – sometimes these patients had no symptoms. The vast majority of patients I see for breast reconstruction with mastectomy have been diagnosed in the early stages of the disease and they mostly have a very good prognosis and can look forward to a fulfilling, healthy life after treatment. Less commonly, patients report to me that there were changes in their nipples that alerted them to the fact that “something was up”. There is a lot of emphasis on lump detection, but there are other signs and symptoms that women and men should be aware of that could be early signs of breast cancer.
- Nipple discharge
It is obviously normal for women who are breastfeeding to have a milky discharge from the nipples. Outside of this, any discharge that can be clear, milky, yellow, green or red should be investigated without delay. The discharge can be from one nipple or both and can be thick or thin in texture.
- Nipple retraction or inversion
Cancerous cell changes behind the nipple can cause the nipple to invert, retract or the areola to appear indented. The size of the nipple areola can also change (shrinking or enlarging). It is important that you observe your nipples during self-examination and note the differences in your nipples appearance due to monthly hormonal fluctuations. If your nipples appear to have altered from your normal – seek medical attention as soon as possible.
Any persistent, crusting, flaking or itching of the nipples should also be checked.
Nipples and breast reconstruction
If the type of breast cancer the patient has, does not affect the nipples AND does not have the potential to affect the nipples then it is possible to do a nipple saving mastectomy and reconstruction.
If however the nipples are affected and need to be removed at the time of mastectomy, there are many ways a plastic surgeon can reconstruct the nipple to make the breasts appear as normal as possible.
- Nipple sharing (using the tissue from the unaffected nipple to reconstruct a nipple on the affected breast).
- Nipple creation using skin flaps or toe pulp and tattooing an areola to match colour and shape of unaffected breasts nipple.
I would like to encourage anyone who receives the diagnosis we all dread to investigate the options available to you for breast reconstruction. There is life after cancer diagnosis and it is my aim as a Plastic and Reconstructive surgeon, to make that life feel as normal and as “whole” as it was before the diagnosis.