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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. Skin-sparing mastectomy is a breast-conserving surgery that offers an improved cosmetic outcome compared to breast surgery, as the breast does not have a large scar and there is no discrepancy in the shape of the breasts as seen with mastectomy. 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:

  • Implant-Based Reconstruction: This method involves inserting a permanent implant that 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.
  • 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 often employed when the patient requires radiation therapy post mastectomy.

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:

  • To prevent the spread of breast cancer
  • Ductal carcinoma in situ (noninvasive breast cancer)
  • Paget's disease of the breast (rare cancer in the skin of or surrounding the nipple)
  • Recurrent breast cancer

Preparation for Skin-Sparing Mastectomy

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

  • A thorough examination by your doctor is performed to check for any medical 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 a mammogram to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anaesthesia, or latex.
  • Inform your doctor of any medications, vitamins, or supplements that you are taking.
  • Refrain from taking any anti-inflammatory drugs, aspirin, or supplements, as they may increase the chance of bleeding.
  • You may be instructed to shower with an antibacterial soap the night prior to 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 areolar or nipple damage, tissue necrosis, and other complications.
  • A written consent will be obtained from you after the procedure has been explained in detail.

Procedure for Skin-Sparing Mastectomy

The procedure is usually performed under general anaesthesia. An incision is made around the nipple and areola, and removes the cancerous breast tissue, leaving behind a natural skin pocket. The pocket may be immediately filled with your own body tissue or a breast implant, or a tissue expander may be inserted, which maintains the space and size of the breast until reconstruction at a later stage. The implant can be supported with a mesh, which acts as an internal bra to hold the device in place. A drainage tube may be placed under each arm to drain excess fluid or blood. Finally, the incisions are closed with sutures and the breasts are wrapped with waterproof dressing.

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.

In general, postoperative care instructions and recovery involve the following:

  • You may notice sensitivity, tenderness, swelling, and bruises over the reconstructed breast. Pain and anti-inflammatory medications are provided as needed.
  • Your physician will also provide you with antibiotics to prevent the risk of infection.
  • Refrain from any physical activity using your upper body or any strenuous activities for at least 4 to 6 weeks to promote healing.
  • You will be able to have a shower in a day or two after surgery. A waterproof dressing will protect your surgical site.
  • Your doctor will provide you with instructions on diet and wound care.
  • You are recommended to wear a supportive bra for at least 2 days post procedure.
  • Refrain from using anything too cold or too hot on your reconstructed breast skin as your breasts will lack normal sensation.
  • You may need to take off from work for at least a week to facilitate recovery.
  • You will be able to resume your normal activities within 4 to 6 weeks, but may have certain activity restrictions.
  • You can drive within 2 to 3 weeks post surgery if you are not using pain medications and you are cleared by your doctor.
  • A periodic follow-up will be scheduled to monitor your overall progress.

Benefits of Skin-Sparing Mastectomy

Some of the benefits of skin-sparing mastectomy include:

  • Minimal scarring
  • Natural-looking breasts
  • Preserves maximum breast skin and tissue
  • Effective and a safe form of mastectomy
  • Superior cosmetic outcome
  • Improvement in self-image, self-esteem, and confidence
  • Form-fitting clothes, sports bras, and swimsuits will feel and look better

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
  • Damage to nerves and blood vessels
  • Swelling in the chest and arm
  • Shoulder stiffness and pain
  • Numbness
  • 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