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Skin-Sparing Mastectomy
Skin-Sparing Mastectomy
Everything You Need To Know Skin-Sparing Mastectomy
What is skin-sparing mastectomy?
Skin-sparing mastectomies typically involve the removal of all breast tissue, including the nipple and, in some cases, the areola, while leaving the majority of the surrounding skin over the breast intact. In some cases, additional lymph node dissections may be performed, such as those of the sentinel lymph node and axillary lymph node, as long as the mastectomy is not prophylactic.
Skin-sparing mastectomies typically involve the immediate reconstruction of the breasts with tissue expanders, breast implants, or tissue flaps. This skin-sparing approach may result in more aesthetically pleasing results than breast reconstruction performed that does not involve sparing the skin.
Who is a suitable candidate for skin-sparing mastectomy?
Most people can have a skin-sparing mastectomy; however, this procedure is not recommended for those who are not undergoing immediate breast reconstruction since the remaining skin may fold and shrink.
Skin-sparing mastectomies are not recommended if the tumour cells are located close to the skin, or if the cancer is confined to the skin. For instance, those with inflammatory breast cancer are not eligible for a skin-sparing mastectomy.
Preparation for skin-sparing mastectomy
In general, skin-sparing mastectomy may involve the following preparatory steps:
- Physician conducts a comprehensive examination to identify any physical, and medical issues that require attention prior to the procedure.
- Depending on the patient’s medical background and age, different types of tests may be required, including blood tests and additional imaging, to identify any anomalies that may compromise the safety of the procedure.
- It is essential to view the ultrasound and mammogram images of the patient during consultation.
- The patient should inform their physician about their allergies, and what vitamins and supplements they are taking.
- Patients can be shown a comparison of before and after images of people who have previously undergone skin-sparing mastectomy to highlight the predicted outcome of the treatment. The patient will be provided with a 3D image of their breasts to determine the volume and shape of other breast for the purpose of planning their reconstruction.
- In some cases, it may also be necessary to reduce or lift the other breast to improve symmetry. This will be discussed during the initial consultation.
- Once the process has been thoroughly outlined and the patient has decided to proceed with the surgery, a written consent will be obtained from the patient.
Procedure for skin-sparing mastectomy
The procedure is typically conducted under general anaesthesia. A surgical incision is made on and around the breast and axillary nodes are accessed via this incision. In all cases, the breast tissue is removed, leaving a natural pocket of skin. This pocket can be filled with the patient’s own tissue or breast implants, or a tissue expander can be inserted to maintain the size and shape of the breast prior to breast reconstruction.
Post-procedure care and recovery for skin-sparing mastectomy
The majority of patients are able to return home within one to two days following surgery, provided there are no complications. The drains typically come out approximately one to two weeks after the procedure. If tissue expanders were used for reconstructive surgery, it is necessary to expand them in order to stretch the underlying skin. During the post-operative visit, additional saline will be applied to the expander to get the desired size.
Risks and complications of skin-sparing mastectomy
Skin-sparing mastectomy is generally considered to be a safe operation; however, like any surgical procedure, there are certain potential risks and complications associated with skin- sparing mastectomy, including:
- Bleeding
- Infection
- Shoulder pain and stiffness
- Breast skin numbness
- Hematoma
- Seroma
- Scar formation
- Anaesthetic risks
- Blood clots
- Fatigue
- Difficulty sleeping
- Phantom breast syndrome
FAQs
The risk of recurrence of breast cancer may be a concern for some, as less skin is removed during a skin-sparing mastectomy than in a conventional mastectomy. However, numerous studies have demonstrated that skin-sparing mastectomies do not increase the risk of recurrence of breast cancer.
According to a study published in Annals of Surgery, patients who underwent skin-sparing mastectomy had a lower incidence of recurrence (4.8%) than those who received non-skin-sparing mastectomy (9.5%).
Skin-sparing mastectomy offers a variety of advantages, including:
- Preserves the aesthetics of the breast
- Improves patient satisfaction
- Maintains breast shape and form
- Facilitates immediate breast reconstruction
Lymphatic mapping involves the administration of a radioactive liquid under the skin close to the location of the cancer. The radioactive fluid circulates through the lymphatic system and forms a visual representation of the lymphatic system. This process is done to assess the lymph nodes for the presence of cancer.
There are a variety of methods available for the reconstruction of a breast, such as abdominal flap reconstruction, commonly referred to as TRAM or DIEP flap. This procedure involves the removal of skin, muscle, and fat from the abdomen and transferring the tissue to the chest. Alternatively, the surgeon may combine muscle and skin taken from the back with breast implants; this procedure is referred to as latissimus muscular flap reconstruction.
The length of time it takes to recover from skin-sparing mastectomy varies greatly from individual to individual. Generally, it takes between six and eight weeks, and in some cases longer to be able to resume normal activities.