What is a Skin-Sparing Mastectomy (SSM)?
A skin-sparing mastectomy, refers to the preservation of the breast skin. This method causes much less scarring than a traditional mastectomy. The skin-sparing mastectomy technique removes breast tissue through an incision near the areola or in the skin fold under the breast. The surgeon leaves most of the breast skin, creating a natural skin envelope, or pocket, that is filled with a breast implant or with the patient’s own tissue from another part of her body. If possible, the nipple is spared, allowing for a nipple-sparing mastectomy. Both techniques significantly improve the cosmetic outcome and gives the best option for reconstruction.
What is a Nipple Sparing Mastectomy (NSM)?
A nipple-sparing mastectomy, refers to the preservation of both. Both methods cause much less scarring than a traditional mastectomy. The nipple-sparing mastectomy technique removes breast tissue through an incision near the areola or in the skin fold under the breast. The surgeon leaves most of the breast skin, creating a natural skin envelope, or pocket, that is filled with a breast implant or with the patient’s own tissue from another part of her body. The nipple sparing techniques significantly improve the cosmetic outcome and gives the best option for reconstruction.
Am I a Skin-Sparing Mastectomy or Nipple-Sparing Mastectomy Candidate?
YES. If breast skin is NOT invaded by cancer. Also, a nipple-sparing mastectomy may not be wise if prior breast surgery of radiation treatment has compromised the integrity of the breast skin.
Who Is a Candidate?
Women who require removal of breast tissue for:
- Early stage breast cancer
- DCIS (Ductal Carcinoma In Situ)
- Prophylactic mastectomy for high risk: BRACA, strong family history, opposite breast cancer
- Lobular carcinoma in situ
Breast cancer of any size or stage that does not invade the skin. (Every woman with disease which has spread beyond the breast may be a candidate for nipple-sparing mastectomy.)
Who Is NOT a Candidate?
Women with breast skin invaded by cancer.
Does a Skin-Sparing Mastectomy or Nipple-Sparing Mastectomy affect my chances of cancer recurrence?
NO. There is no increased risk of cancer recurrence with nipple-sparing mastectomy. Studies and research published in medical literature shows that a nipple-sparing mastectomy does not affect the risk of disease recurrence. The nipple-sparing mastectomy not only causes less scarring, it is an equally effective cancer treatment. For more information on research and studies that have been conducted click on the links below.
THE AMERICAN SURGEON, October 2008
San Antonio Breast Cancer Symposium, December 2008
MD Anderson study: Local-regional and distant reoccurrence rates after standard versus skin-sparing mastectomy
Skin-Sparing Mastectomy and immediate reconstruction: More indications with no increased in reoccurrences in breast cancer patients
Are there medical disadvantages of a Skin-Sparing or Nipple-Sparing Mastectomy?
There are no medical disadvantages to the patient. However, a nipple-sparing mastectomy is more difficult to perform and can be more time consuming. General and breast surgeons may need additional training to learn the operation.
What are the emotional and physical advantages of a Skin-Sparing Mastectomy or Nipple-Sparing Mastectomy?
A better cosmetic result after breast cancer surgery for many women greatly helps restore her to her former life. This includes an aesthetic looking breast(s), properly fitting clothes and the feeling that her womanhood and sexuality are still intact. The use of plastic surgery techniques to remove the diseased breast tissue may allow for improvement in breast shape and enhancement of breast size if desired. For example, this technique allows the surgeon to lift a droopy breast, or increase breast size by the use of a larger implant.
Can I have immediate reconstruction with a skin-sparing or nipple-sparing mastectomy?
Yes. Immediate reconstruction is an advantage, but future reconstruction or no reconstruction is also an option. Typically, a nipple-sparing mastectomy is the best option for women deciding to have breast reconstruction, as long as there is no cancer involved with the breast skin.
If I don’t have a Skin-Sparing Mastectomy or Nipple-Sparing Mastectomy at the time of mastectomy, can I have reconstruction later?
Usually yes, but a Plastic surgeon should be consulted before mastectomy to be sure. This answer is also dependent upon where the incisions are made and how much breast skin is saved. The incisions made without breast preservation in mind make achieving a natural looking breast very difficult! This is why we advocate asking about the procedure before a mastectomy is performed.
Will my health insurance cover a Skin-Sparing Mastectomy or Nipple-Sparing Mastectomy?
Usually. If you are adequately insured, you will be covered for either a traditional mastectomy or a nipple-sparing mastectomy. A skin-sparing or nipple-sparing operation usually takes longer, due to the extra time the surgeon needs to mark and make the minimal incisions to preserve the breast skin and nipple. Reconstruction of the involved breast and plastic surgery to improve symmetry of the uninvolved breast is frequently covered by insurance. But you need to find out what your specific carrier covers and advocate for the best result for you.
What is Oncoplastic Surgery?
Oncoplasty refers to the combination of cancer, or oncological, surgery with techniques of plastic surgery. It is a new term, in an emerging field, in which cancer surgeons use plastic surgery techniques to improve the cosmetic outcome for their cancer patients.
Does it matter what type of surgeon performs the mastectomy?
It Depends. The surgeon may be a breast surgeon, oncoplastic surgeon or general surgeon. The key is that the surgeon is trained to do nipple-sparing mastectomy. The best results are obtained by surgeons who perform the procedures frequently.
Does it Matter What Type of Surgeon Performs the Breast Reconstruction?
Yes. Plastic surgeons (certified by the American Board of Plastic Surgery) are the only surgeons trained at this time to perform breast reconstruction. The surgeon performing the mastectomy needs to work collaboratively with the plastic surgeon for the best result. Resources to seek out Plastic Surgeons: American Society of Plastic Surgeons;American Society of Breast Disease
Should I trust my oncologist and surgeon to make the best decision about my mastectomy and reconstruction?
It depends. Unfortunately, not all doctors are up-to-date on the latest advances in surgical techniques for mastectomy. Women need to advocate for the best care available, not only for treating their cancer, but also for preserving the appearance of their breasts. The Breast Preservation Foundation encourages women to become educated regarding breast cancer surgery. We strongly encourage women to convey to their surgeon the importance of the appearance of their breast and insist upon the involvement of a Board certified Plastic Surgeon before any surgery is done.
How do I find a surgeon skilled in performing a Skin-Sparing Mastectomy or Nipple-Sparing Mastectomy?
See the Ask Your Surgeon section on our website. Print and be prepared to ask a lot of questions.