Skin Sparing in Mastectomy and Reconstruction

Skin Sparing MastectomySkin-sparing mastectomy was developed to minimize the deformity that results following removal of breast tissue for treatment of breast cancer. Two generations ago, skin muscle, nipple and all the surrounding lymph nodes were removed at the sign of breast cancer and this resulted in a cure. Over the years through intensive studies, it became obvious that the breast tissue is not usually associated with the breast skin so removal of the cancer could be safely performed scooping it out like taking a walnut out of its shell, leaving the skin muscle and lymph nodes intact if they were not involved.

Today, most patients are detecting their cancers early through revolutionary new diagnostic imaging techniques and screenings. Many cancers can be detected while in the microscopic phase and removal of the cancer alone will leave the adjacent tissues including the nipple and areolar in place.

When patients have breast implants placed under the muscle for cosmetic purposes and then require the breast tissue above the muscle removed to treat cancer, reconstruction is performed by removing the breast tissue leaving the skin and nipple completely intact. Later, exchanging the underlying sub-muscular implant for a larger one. This leaves the patient with an almost identical appearing breast as they had before mastectomy.

The term skin sparing relates to removal of the nipple areolar complex leaving all the skin. The term nipple areolar-sparing has come to include all of the skin and the nipple areolar complex. Most mastectomies performed today that are detected as micro-invasive or non-invasive diseases are treated with nipple-sparing mastectomy and the breast is replaced with the body’s own natural tissue or implantable devices.

The evolution of breast reconstruction has allowed surgeons to remove early cancers and preserve a nearly identical appearing breast. Success in reconstruction involves achieving size, shape and symmetry that was comparable or better to that which existed before. Unfortunately, the presence of scars is a necessary trade-off in efforts to replace the diseased breast tissue. In addition, the reconstructed breast generally has less sensation than the non-reconstructed breast. There is also a difference in feel of the natural breast and the implant despite the improvements in implant technologies. Natural breast tissue reconstructions with belly flap or back flap can achieve a completely normal appearing breast that feels identical to natural breast tissue when it is uncomplicated.

As you begin to schedule your consultations, be sure to do extensive research and ensure you are in the hands of a qualified surgeon with training and experience in breast reconstruction, as this field has evolved dramatically over the past decade. No one option is “the best” and trade-offs must be discussed with your reconstructive surgeon to achieve a custom plan that works best for you.