One Woman’s Experience With Nipple-Sparing Mastectomy

For generations, mastectomy meant survival at the expense of identity—scars that altered both body and spirit. Today, an innovative approach is changing that narrative. Nipple-sparing mastectomy (NSM) preserves not just anatomy, but a woman’s sense of self. 

What is NSM?

NSM is an advanced surgical technique that removes breast tissue, while preserving the skin, nipple and areola. Unlike traditional mastectomy, which can leave visible scars and alter your chest’s appearance, NSM enables reconstruction that closely resembles your natural breast.

“Because the skin envelope and nipple–areola complex remain intact, the breast retains a more natural shape and appearance compared to traditional mastectomy,” says Susan Kesmodel, M.D., director of breast surgical oncology and co-leader of the Breast Site Disease Group at Sylvester Comprehensive Cancer Center, part of UHealth – University of Miami Health System. “The external appearance can often look nearly indistinguishable from a natural breast—sometimes almost identical in clothes or at a glance.”

And the benefits extend well beyond aesthetics.

“NSM can ease the psychological and emotional burden of a cancer diagnosis, helping patients maintain a stronger sense of body image and sexual well-being after surgery,” adds Dr. Kesmodel.

A Patient’s Perspective

For patients like Lourdes Milian, NSM provided not only a medical solution but also emotional reassurance and confidence during a challenging time.

In June 2022, at just 41 years old, Milian’s life changed dramatically when a routine mammogram revealed she had stage 0 ductal carcinoma in situ (DCIS). Despite feeling healthy and experiencing no symptoms, the discovery weighed heavy, especially given her family history of cancer.

With guidance from her surgical oncologist, Dr. Kesmodel, Milian chose a path that promised hope, healing and wholeness.

“My team explained every option, but I knew the final choice had to be mine,” says Milian. “I made my decision and never looked back.”

With three young children and a deep fear of recurrence, Milian chose a double mastectomy over radiation, prioritizing both her health and peace of mind. Despite the tumor’s proximity to her nipple, she chose NSM to preserve her chest’s natural appearance. A second surgery was possible, but her trust in her team outweighed the risk.

“I wanted to look and feel like myself again, without the constant visual reminder of cancer,” says Milian.

The surgery was successful, and she has remained cancer-free for three years. She is filled with gratitude—for her recovery, her dedicated care team and the future she now embraces with her family.

Who Is a Candidate for NSM?

The best candidates for NSM are those whose cancer and body type make it possible to safely keep the nipple and areola, without raising the chances of cancer recurrence or surgical complications. Also, the results depend on several key factors including breast size, tumor location, skin quality and the reconstructive technique.

NSM may be right for you if you have:

• Early-stage breast cancer where the tumor is small and not close to the nipple–areola complex.
• DCIS (ductal carcinoma in situ) that does not involve tissue directly beneath the nipple.
• Decided on risk-reducing mastectomy for those at high genetic risk (e.g., BRCA mutation carriers) without active cancer.
• Favorable breast anatomy (small-moderate breast size, minimal drooping, adequate blood supply to nipple).

You are not a candidate if you have:

• Tumors close to, or involving, the nipple–areola complex.
• Locally advanced or inflammatory breast cancer.

While patients who have had prior radiation therapy or are active smokers may be considered for the procedure, the risk of complications is higher.

Dr. Kesmodel emphasizes that patients should meet with their full care team to review options and potential outcomes before making any treatment decisions.

Surgical Innovation at Sylvester

At Sylvester, Dr. Kesmodel is advancing breast cancer surgery with techniques that may preserve nipple sensation and minimize trauma, giving patients both effective treatment and a better quality of life.

She collaborates with a multidisciplinary team—including plastic surgeon Devinder Singh, M.D., chief and program director of the Division of Plastic Surgery, and oncologist Frances Valdes, M.D., assistant professor of clinical medicine—ensuring every patient receives comprehensive, individualized care.

Sylvester also leads clinical research, reinforcing its role as a national leader in breast cancer surgery—where innovation, evidence and patient-centered care converge to set a higher standard of treatment defined by both precision and compassion.

Written by Debby Teich for Sylvester Comprehensive Cancer Center.

Tags: breast cancer, Dr. Devinder Singh, Dr. Frances Valdes, Dr. Susan Kesmodel, nipple sparing mastectomy, Sylvester Comprehensive Cancer Center