During a conventional mastectomy, all your breast tissue is removed to treat breast cancer. A skin-sparing mastectomy is a newer technique that tries to preserve as much of the skin as possible.
The main benefit of this procedure is that your surgeon won’t have to use skin from other parts of your body during breast reconstruction. Skin from other body parts can have a different thickness, texture, and color compared to your breast skin.
A skin-sparing mastectomy offers a more realistic look.
What Is a Mastectomy?
A mastectomy is the surgical removal of your entire breast. There are a few different types of mastectomies:
- Total (simple) mastectomy: Your breast and chest muscle lining are removed.
- Modified radical mastectomy: Your breast, chest muscle linings, and the lymph nodes in your underarm are removed.
- Skin-sparing mastectomy
- Nipple-sparing mastectomy: This is a skin-sparing mastectomy that also preserves your areola and nipple.
A mastectomy may be needed when you:
- Have calcium deposits (microcalcifications) throughout your breast that are widespread and cancerous
- Have two or more tumors in separate areas of your breast
- Are pregnant and are concerned about radiation therapy affecting your unborn child
- Previously had radiation therapy in the breast area, and breast cancer has returned
- Have a connective tissue disease, like lupus or scleroderma due to which you may not tolerate the side effects of radiation to the skin after lumpectomy
- Have a large tumor. If you have a lumpectomy, there may not be enough healthy tissue left to get a good cosmetic outcome.
- Have a gene mutation with a high risk of getting cancer in your breast
- Had a partial mastectomy (lumpectomy), but cancer is still found at the edges of the surgical site
Can Anyone Have a Skin-Sparing Mastectomy?
Most people can have skin-sparing mastectomies, but it’s not recommended if you aren’t having immediate breast reconstruction, as the remaining skin may fold and contract.
It's also not recommended if you have tumor cells that are close to your skin or if the cancer involves your skin. If you have inflammatory breast cancer, for example, you are not a good candidate for a skin-sparing mastectomy.
Will a Skin-Sparing Mastectomy Risk a Breast Cancer Recurrence?
Because less skin is removed in a skin-sparing mastectomy compared to a conventional mastectomy, you might fear that your breast cancer will return. Several studies have shown, though, that skin-sparing mastectomies don't have a higher risk of recurrence.
One study, in fact, showed a lower risk of recurrence. Of 435 people who had mastectomies, it was found that local recurrence of cancer happened after 4.8% of skin-sparing mastectomies. For non-skin-sparing mastectomies, 9.5% of people had local recurrences.
How Is a Skin-Sparing Mastectomy Done?
Your surgeon will remove your nipple and areola, as well as your biopsy scar. Through the small opening, they will remove your breast tissue. Your surgeon will preserve as much breast skin as possible. They will use this remaining skin in the reconstruction of your breast.
How Is Breast Reconstruction Done After Skin-Sparing Mastectomies?
There are a few different options for breast reconstruction after a skin-sparing mastectomy.
TRAM flap reconstruction: In this surgery, your surgeon will take fat, muscle, and skin from your abdomen, just below your navel. This is used to reconstruct your breast. Using your body’s tissue means that the reconstructed breast feels soft and natural.
You may not be a candidate for TRAM flap reconstruction if you’ve had abdominal surgery or don’t have excess abdominal tissue.
Deep inferior epigastric perforator (DIEP) flap reconstruction: This procedure uses skin and fatty tissue from your lower abdomen. Unlike the TRAM flap method, your muscle isn’t used, but this is also a longer and more complex surgery because of the microvascular procedures used.
Latissimus muscle flap reconstruction: This method uses an implant and the latissimus muscle from your back to reconstruct your breast.
The amount of soft tissue in your latissimus muscle is limited, so an implant is usually needed to give your breast more volume. Your muscle tissue is placed over the implant so that your breast will feel more natural.
You’ll have a much smaller breast scar after this surgery, but there will be a long back scar.
What Can I Expect After a Skin-Sparing Mastectomy?
Recovery from a skin-sparing mastectomy is the same as in a conventional mastectomy. Here’s what to expect after your mastectomy:
After a mastectomy, you may stay in the hospital for a few days. If you had a mastectomy and reconstruction, your stay may be longer.
You may have surgical drains in your armpit or breast area. You’ll have to remove the fluid from the drains a few times a day. These drains may stay inserted until your first follow-up visit, about one to two weeks after surgery.
Take sponge baths until your sutures and drains are removed.
It takes time to recover from surgery, so allow yourself extra rest for the first few weeks. Let your family and friends help out around the house, provide childcare, and go shopping.
Your medical team may teach you some exercises to prevent arm and shoulder stiffness. Do these exercises regularly. You may have to avoid some exercises until the surgical drains are removed.
Your surgery site needs time to heal before you can wear a bra. Ask your doctor how long you have to wait.