Skin-sparing mastectomy: Benefits and options
As a result of a mastectomy, women are often left with large scars across their chests. The skin-sparing mastectomy was developed to help address this issue of scarring. This procedure also helps make reconstruction of the breast easier.
What is a skin-sparing mastectomy?
A skin-sparing mastectomy will leave most of the breast's skin intact, making the reconstruction process easier.
A skin-sparing mastectomy is a surgical procedure that involves the removal of all breast tissue and glands but leaves the skin of the breast mostly intact. The skin is then used in breast reconstruction to make the breast look more natural.
The nipple, the surrounding skin (areola), and the original biopsy scar are all removed. The surgeon works through the openings created from these areas and preserves as much of the skin surrounding the breast tissue as is possible.
The results from a skin-sparing mastectomy are considered just as safe and effective at removing cancer tissue as other methods.
The skin-sparing mastectomy can be done with simple mastectomies, as well as those that involve the removal of lymph nodes under the arm.
Most women are candidates for the skin-sparing mastectomy. However, a doctor may not recommend the skin-sparing mastectomy in the following situations:
- if there is a possibility that tumor cells are too close to the skin
- if the skin may be a part of the tumor, as in inflammatory breast cancer
- if the woman is not seeking to have reconstructive surgery immediately following the mastectomy
If a woman does not wish to have reconstructive surgery right away, a surgeon will remove as much of the breast and skin to reduce scarring and make the areas as flat as possible.
Most women who opt for a mastectomy can benefit from a skin-sparing mastectomy.
During a total mastectomy, the skin is also removed. This procedure results in scarring and causes problems when making the reconstructed breast look natural. A skin-sparing mastectomy allows surgeons to reconstruct the breast in a more natural way, with minimal scarring.
Although the primary benefit of a skin-sparing mastectomy may appear to be how the body looks afterward, people should not discount the psychological effect having a mastectomy can have on a woman.
The ability to preserve a part of her body can help improve symptoms of depression that can accompany mastectomies and cancer. The skin-sparing mastectomy can help a woman feel normal after treatment.
Skin-sparing mastectomies are just as safe and effective as other forms of mastectomy. In some cases, they are becoming the most common type of mastectomy performed at a hospital.
Other mastectomy options
The length of the recovery will depend on whether the woman choses to have reconstructive surgery at the same time.
There are many options available for women whose breast cancer treatment requires them to have a mastectomy.
Women should consult with their surgeon to discuss the various options available and to decide which procedure is the most suitable.
Additional mastectomy options include the following:
Total simple mastectomy
A total simple mastectomy involves the removal of the breast, nipple, and areola. The lymph nodes from the armpits remain in place after the surgery.
If the woman opts not to have reconstructive surgery at the same time, she should make a full recovery in about 1 to 2 weeks. Some women will be able to go home on the day of their surgery. Others may require an overnight stay in the hospital.
Modified radical mastectomy
A modified radical mastectomy is the removal of the breast, nipple, areola, and lymph nodes in the armpit. Without reconstruction, the recovery time is between 2 and 3 weeks.
A nipple-sparing mastectomy removes the breast tissue and preserves the skin, nipple, and areola. Cuts are often hidden underneath the breast or may be made through the armpit area.
The surgery can involve immediate reconstruction. In some cases, the breast reconstruction takes place at the same time as the surgery. In other situations, a surgeon may insert a tissue expander as a space holder for later reconstruction.
A scar-sparing mastectomy is a newer form of surgery. With this option, the breast is hollowed out. The goal is to minimize the number of visible surgical cuts.
The method can be used with many different types of mastectomy, including those that preserve the skin, nipple, areola, or a combination of all three.
A risk-reducing mastectomy is designed to remove one or both breasts with the aim of dramatically reducing the risk of breast cancer developing.
This surgery option is ideal for women who test positive for certain genetic mutations, such as BRCA1 and BRCA2. Women who have a strong family history of breast cancer might also consider a risk-reducing mastectomy.
A woman may also choose to have their ovaries removed at the same time.
The reconstruction process will depend on the stage of the cancer, as it may require further treatment.
There are a few reconstruction options for women who have skin-sparing mastectomies. The best option for each woman will depend on factors that include:
- stage of the cancer
- whether additional treatment is needed
- the person's choice
- expertise available in the area
The following are two of the options for reconstruction after a skin-sparing mastectomy:
In this option, reconstructive surgery begins straight after the removal of the breast tissue.
This technique requires the coordination between the breast cancer surgeon and the plastic surgeon. With this method, the woman will wake with her breasts restored.
Delayed immediate reconstruction
In some cases, doctors may not be sure how effective the mastectomy is until after the surgery. When this happens, a surgeon can place a tissue expander under the skin to hold the space temporarily. The doctor will remove the expander when the reconstruction happens.
The delayed immediate reconstruction method allows the medical team treating the cancer to use other treatments, such as radiation, before reconstruction.
An additional option available for women who choose a traditional mastectomy is called a delayed reconstruction. This method is not available for women who have skin-sparing mastectomies, however, as a skin-sparing mastectomy requires an immediate reconstruction option.
Some women may not want immediate reconstruction and may choose to wait several months or even years before having the procedure. In these cases, a doctor can continue to treat the breast cancer without interference from the reconstruction.
Recovery and outlook
After a mastectomy, most women can expect to make a full recovery.
Typical complications include:
- temporary shoulder stiffness or pain
- swelling of the arm or breast at the site of the surgery
- damage to the nerves around the breast
As with any cancer, there is a chance of it returning or further treatment being required. A doctor will discuss with the woman what further treatments should be pursued. These may include hormone therapy and radiation.