Skin Sparing Mastectomy

What is Skin Sparing Mastectomy?

Mastectomy is a surgical procedure to remove one or both breasts to treat or prevent the spread of breast cancer. It usually involves removal of the breast tissue, nipple, and areola. Skin sparing mastectomy involves the removal of all of the breast tissue including the nipple yet preserving as much of the breast skin as possible. This method is an option for many women who desire to have immediate breast reconstruction after mastectomy.

Some of the most common methods of immediate breast reconstruction include:

• Tissue Expanders: These are temporary implants that are placed behind the chest muscle to expand the area and make room for implant reconstruction. This method is mostly employed when the patient requires radiation therapy post mastectomy.
• Implant-Based Reconstruction: This method involves inserting a permanent implant which is filled with silicone gel or saline (saltwater) under the skin and muscle of the chest to create a new breast mound.
• Flap or Autologous Reconstruction: In this method, the patient’s own skin tissue is taken from another section of the body, such as the stomach, thigh, or buttocks and used to create a new breast mound.

Indications for Skin Sparing Mastectomy

Skin sparing mastectomy is indicated for patients who wish to preserve the original appearance and shape of the breast with superior cosmetic results. Some of the indications for skin sparing mastectomy include:

• When cancer is too close to the nipple
• Paget's disease of the breast (rare cancer in the skin of or surrounding the nipple)

Preparation for Skin Sparing Mastectomy

In general, preparation for skin sparing mastectomy may involve the following:

• A thorough history taking and examination by Dr Meybodi is performed to check for any physical, medical and social circumstance. Address issues that need to be addressed prior to the procedure.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and more imaging to help detect any abnormalities that could threaten the safety of the procedure.
• It is important to bring your mammogram and ultrasound images for consultation.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• Inform us of any medications, vitamins, or supplements that you are taking.
• You will review before and after surgery pictures of patients with similar breat size and shape who had skin Sparing Mastectomy.
• You will have a 3D photo to measure your other breast volume and shape for planning of your reconstruction.
• In some scenarios, the other breast also might need some procedures like a reduction or lift to achieve better symmetry. That will be discussed in the initial consultation.
• A written consent will be obtained from you after the procedure has been explained in detail, and you made your mind to proceed.

Preparation for the Surgery

• Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing and increase your chances of skin necrosis, and other complications.
• Maintain a moderated level of physical activity to enhance your physical and mental fitness in preparation for your surgery.
• You can find out more about how you prepare yourself and your home environment before surgery here.

On the day of surgery:

• You may be instructed to shower with an antibacterial soap in the morning of your surgery.
• You should not consume any solids and liquids 8 and 4 hours prior to surgery.
• You might need a lymphatic mapping the day before or on the same day of surgery.
• Please bring all your images to the operating theatre.

Procedure for Skin Sparing Mastectomy

The procedure is usually performed under general anaesthesia. The incision is commonly placed on the breast and around the nipple. This incision is also used for access to the axillary nodes.

In all instances, the breast tissues are removed, leaving behind a natural skin pocket. The pocket may be immediately filled with your own body tissue or a breast implant, or a temporary tissue expander may be inserted, which maintains the space and size of the breast until breast reconstruction is performed. Detail of reconstruction has been explained on another page.

Post-Procedure Care and Recovery

Most patients can go home in a day or two after surgery if no complications are noted. The drains are usually removed in about a week or two from the surgery. Post-procedure care and recovery has been discussed in detail on immediate reconstruction page. If a tissue expander used for reconstruction, it needs expansion to stretch the overlying skin. In your post-operative appointment, more saline (saltwater) will be injected to the device to achieve the appropriate size.

Benefits of Skin Sparing Mastectomy

Some of the benefits of skin sparing mastectomy include:

• Improves aesthetic outcomes
• Improves patient satisfaction
• Helps to preserve aesthetics of the breast
• Helps to maintain breast shape and form
• Facilitate immediate breast reconstruction

Risks and Complications of Skin Sparing Mastectomy

Skin sparing mastectomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Infection
• Bleeding
• Shoulder stiffness and pain
• Numbness of breast skin
• Hematoma (accumulation of blood in the wound)
• Seroma (accumulation of clear fluid in the wound)
• Scar formation
• Anaesthetic risks
• Blood clots
• Fatigue and difficulty sleeping
• Phantom breast syndrome