Paget’s disease of the nipple - Treating Paget's disease of the nipple

Paget’s disease of the nipple is often associated with other forms of breast cancer.

It's usually treated in the same way as more common types of breast cancer, either by removing the cancerous section of the breast or sometimes by removing the entire breast – a procedure known as a mastectomy (see below).

You can discuss any concerns you have with your oncologist (cancer specialist) who will be able to explain each phase of your treatment.

Surgery

If you're diagnosed with Paget’s disease, surgery is often the first form of treatment you will receive. There are two main types of surgery. They are:

• mastectomy – surgery to remove the whole breast, which can be followed by reconstructive surgery to recreate the removed breast
• breast-conserving surgery – surgery to remove the cancerous lump (tumour) in your breast

These types of surgery will also involve removing your nipple and the darker area of skin surrounding it (the areola).

The two different types of surgery are discussed in more detail below.

Mastectomy

A mastectomy removes all your breast tissue, including your nipple. You may need to have a mastectomy if:

• the tumour is large or in the centre of your breast
• there is more than one area of breast cancer
• breast conserving surgery (see below) is not able to provide acceptable results

If lymph nodes (small glands) are removed from your armpit during a mastectomy, the scarring may block the filtering action of the lymph nodes, resulting in a condition called lymphoedema. This is a long-term condition, but can be treated with:

• massage
• compression sleeves – tightly fitting bandages that push excess fluid out of your arm

Lymphoedema can develop months or sometimes years after surgery. See your breast care nurse or GP if you notice any swelling in your arm or hand on the side of your operation.

Read more about mastectomy, including information and advice about recovery and possible complications.

Breast-conserving surgery

Breast-conserving surgery aims to save as much of your breast as possible while removing the cancer with a rim of healthy tissue.

If you have Paget’s disease, your nipple and areola will be removed. You should be offered reconstructive surgery to improve the appearance of your breast after surgery (see below).

If you have breast-conserving surgery, the amount of breast tissue removed will depend on:

• the size of the tumour in relation to the size of your breast
• whether the tumour is in one place or scattered throughout your breast

Your surgeon will remove an area of healthy breast tissue around the cancer so it can be tested for traces of cancer.

If cancer cells are found in the surrounding tissue, you may need to have more tissue surgically removed from your breast.

After having breast-conserving surgery, it's likely you will need radiation treatment (radiotherapy) to destroy any remaining cancer cells.

Breast reconstruction

If you have a mastectomy, you may be able to have reconstructive surgery to recreate your breast. This can be done by:

• inserting a breast implant
• using tissue from another part of your body to create a new breast

The reconstruction can be carried out at the time of your mastectomy or at a later stage. You should discuss your options fully with your surgeon and breast nurse before making a decision.

For example, it may be possible to have reconstructive surgery after breast-conserving surgery to improve the appearance of your breast and create a nipple.

Creating a nipple

A nipple can be created by:

• having a nipple tattooed onto the skin
• using your own body tissue, such as tissue from your other nipple, although around half of these flatten out and shrink over time
• using a stick-on latex (rubber) nipple, which can be made from a mould of your other nipple so that they are identical; you stick it on every day with glue and it can be removed for washing

Prostheses

If you decide not to have breast reconstruction, you can wear a false breast or breast prosthesis, which are available free on the NHS.

After having a mastectomy, you may have a temporary, fibre-filled prosthesis and a permanent prosthesis made from silicone, which can be replaced every two years.

Further treatment

After your surgery, you may need further treatment if you have invasive breast cancer, where the cancerous cells have spread into other tissue in your breast.

If you had non-invasive breast cancer, where the breast cancer cells were contained in one area of your breast, surgery may be all the treatment you need.

Other types of treatment for breast cancer include:

• chemotherapy – cytotoxic medication that prevents cancer cells from dividing and growing is used to destroy cancer cells
• radiotherapy – where controlled doses of high-energy radiation, usually X-rays, are used to destroy cancer cells
• biological therapy – if your breast cancer is HER2 positive, biological therapy, usually a medication called trastuzumab, can be used to treat the cancer by stopping the effects of HER2 and helping your immune system fight off cancer cells
• hormone therapy – if your breast cancer is hormone-receptor positive, hormone therapy can be used to treat the cancer by lowering the levels of hormones in your body or stopping their effects

Read more about how breast cancer is treated.