SKIN AND NIPPLE SPARING MASTECTOMY

What is Skin and Nipple Sparing Mastectomy?

A mastectomy is a surgical procedure to excise (remove) one or both breasts to treat or prevent breast cancer. Traditionally, this involves removing breast tissue, the nipple, and the areola, resulting in a flat closure. In a Skin Sparing (or Nipple sacrificing) mastectomy, all breast tissue and the nipple are removed, but as much of the breast skin as possible is preserved. With Nipple sparing, the Nipple is preserved.

Women who plan to have breast reconstruction after mastectomy; either immediate or delayed often opt for these procedures.

How do we do Immediate Breast Reconstruction?

Tissue Expanders: Temporary implants placed in front of the chest muscle to expand the area for future implant reconstruction, often used when post-mastectomy radiation therapy is anticipated or required.
Implant-Based Reconstruction: Insertion of a permanent implant filled with silicone gel under the skin flaps to create a new breast mound. A pocket may be created using a mesh or a mesh like substance.
Flap or Autologous Reconstruction: Using the patient’s own tissue from another body part, such as the lower abdomen, thigh, or buttocks, to create a new breast mound.

What are the Indications for Skin Sparing (Nipple sacrificing) Mastectomy?

This procedure is needed when we can’t preserve the nipple, but patients wish to preserve the original appearance and shape of the breast with better aesthetic results. It is indicated when:

Paget’s disease of the breast
Cancer is close to the nipple, or within the nipple ducts

How do you plan for Nipple and Skin Sparing Mastectomy?

Before Surgery:

Avoid smoking as it can impede healing.
Maintain moderate physical activity for overall fitness.

Day of Surgery:

Shower with antibacterial soap.
Fast from solids and liquids as instructed by the hospital
Lymphoscintigram may need to be done on the day before or the same
day.
Bring all medical images to the operating room.

What is the procedure for Skin Sparing Mastectomy?

Performed under general anaesthesia, the incision is made on the breast and around the nipple, also allowing access to the axillary nodes. All breast tissue is removed, leaving a natural skin pocket, which may need to be reinforced by a mesh. This pocket can be immediately filled with body tissue, a breast implant, or a temporary tissue expander. We insert drains
to remove excess fluid to help healing.

What is the Post-Procedure Care and Recovery?

Patients typically go home within one or two days post-surgery. Drains are usually removed within one or two weeks. If a tissue expander is used, it will require periodic expansions during post-operative appointments to achieve the desired breast size. This is done with painless Saline injections by your surgeon.

What are the benefits of Skin and Nipple Sparing Mastectomy?

Allows immediate breast reconstruction, you wake up with both breast
mounds in place, reducing the sense of loss from a traditional mastectomy
Preservation of breast aesthetics, with enhanced aesthetic outcomes,
maintenance of breast shape and form
Immensely increased patient satisfaction, having the cancer/at risk
breast tissue removed, and a reasonable reconstruction in place