A mastectomy is a standard treatment for breast cancer. It is a surgical procedure in which the surgeon removes one or both breasts, as well as much of the skin. A skin sparing mastectomy involves the removal of all breast tissue and glands but preserves the skin in the region of the breast, which can provide a range of benefits and support recovery.
For example, surgeons can use the skin in a breast reconstruction procedure to make the breast look more natural. Also, while a standard mastectomy can leave a person with large scars across their chest, a skin sparing mastectomy can help resolve scarring.
In this article, we look at the benefits of skin sparing mastectomies and explain what other types of mastectomy are available.
Most people who choose a mastectomy are likely to benefit from a skin sparing mastectomy.
Surgeons remove the skin, glands, and tissue during a traditional mastectomy. This procedure results in scarring and can cause problems with making the reconstructed breast look natural. A skin sparing mastectomy allows surgeons to reconstruct the breast in a more natural way, with minimal scarring.
Although the primary benefit of a skin sparing mastectomy may seem to be the appearance of the breast afterward, a mastectomy can have a lasting psychological impact on the person.
The ability to preserve a part of the body may help improve the symptoms of depression that can sometimes accompany breast cancer and mastectomy.
Skin sparing mastectomies are just as safe and effective as other forms of mastectomy. In some hospitals, they are becoming the most common type of mastectomy.
In a skin sparing mastectomy, the surgeon removes the nipple and its surrounding skin, as well as the original biopsy scar.
Removing these creates openings in the skin through which it is possible to perform the surgery. The surgeon preserves as much of the skin surrounding the breast tissue as possible.
This type of mastectomy is equally effective as other types in the removal of the cancerous tissue.
Skin sparing is possible as part of simple mastectomies, as well as those that involve the removal of lymph nodes under the arm if cancer has spread to these areas.
Most people with breast cancer are potential candidates for a skin sparing mastectomy. However, a doctor may not recommend the skin sparing mastectomy if:
- there is a possibility that the tumor cells are too close to the skin
- the skin may form a part of the tumor, for example, in people who have inflammatory breast cancer
- the individual is not seeking to have reconstructive surgery immediately after the mastectomy
Whether or not a person smokes may also affect the doctor's decision. Smoking is a relative contraindication as research has linked it with impaired wound healing.
If a person does not wish to have reconstructive surgery immediately after a mastectomy, a surgeon will remove as much of the breast and skin as possible to reduce scarring. They will aim to leave the areas as flat as possible.
Several types of mastectomy are available for people who need this procedure:
- Simple mastectomy or total mastectomy: This procedure involves the removal of the breast, nipple, and areola. The lymph nodes in the armpits remain after the surgery.
- Modified radical mastectomy: This mastectomy involves the removal of the breast, nipple, areola, and lymph nodes in the armpit.
- A nipple sparing mastectomy: In this procedure, a surgeon removes the breast tissue and preserves the skin, nipple, and areola. They will often hide cuts underneath the breast or make incisions through the armpit area.
- A scar sparing mastectomy: In this newer form of surgery, the surgeon hollows out the breast. The goal is to minimize the number of visible surgical cuts. Surgeons can use scar sparing techniques during many different types of mastectomy.
- Risk reducing mastectomy: A surgeon removes one or both breasts, which dramatically reduces the risk of breast cancer developing. This option is suitable for those who test positive for certain genetic mutations, such as those in the BRCA1 and BRCA2 genes. Women who have a strong family history of breast cancer might also consider a risk reducing mastectomy and request the removal of their ovaries at the same time.
A person should consult a surgeon to discuss the various options available and to decide which procedure is most suitable for them.
In some cases, a surgeon may reconstruct the breast at the same time as performing the mastectomy. In others, they may insert a tissue expander to preserve space in the breast for later reconstruction.
Some people will be able to go home on the day of their surgery. However, others may need to spend up to 3 days in the hospital, depending on whether they choose to have reconstruction at the same time as their mastectomy.
There are two reconstruction options for people who have skin sparing mastectomies. The best option for a person will depend on factors that include:
- the stage of the cancer
- the possible need for additional treatment
- personal choice
- the services and expertise available in the area
In this option, reconstructive surgery begins straight after the removal of the breast tissue.
This technique requires coordination between the breast cancer surgeon and the plastic surgeon. The surgical team will have restored the breast before the person wakes from anesthesia.
Delayed immediate reconstruction
In some cases, doctors may not be sure about the effectiveness of a mastectomy until after surgery. In these circumstances, a surgeon can place a tissue expander under the skin to temporarily preserve the space. The plastic surgeon will remove the expander during reconstruction.
A delayed immediate reconstruction allows the medical team to use other cancer treatments, such as radiation therapy, before reconstruction.
People having other types of mastectomy may choose to postpone reconstruction. However, this is not possible following a skin sparing mastectomy.
After a skin sparing mastectomy, most people can expect to make a full recovery.
Typical complications include:
- temporary shoulder stiffness or pain
- swelling of the arm or breast at the site of incision
- damage to the nerves around the breast
There is also a risk of the cancer returning or a possible need for further treatment. A cancer specialist, called an oncologist, will discuss possible further treatments with the individual following a mastectomy.
These may include:
- hormone therapy
- radiation therapy
- targeted therapy
However, the outlook for people with a breast cancer diagnosis is generally good, depending on the stage and spread of the cancer.
On average, the 5-year relative survival rate for women with breast cancer in the U.S. is 90%. This statistic means that a woman with breast cancer is 90% as likely to survive for 5 years after diagnosis as a woman who does not have breast cancer.
However, this figure only takes into account the stage of a cancer at the point of diagnosis, but cancer may get worse or return more aggressively following treatment. It also does not consider other factors, such as age and the response of cancer to treatment.
A skin sparing mastectomy does not reduce the risk of recurrence any more than other types. However, it can make the psychological effects of the procedure easier to manage.
Will my insurance cover skin sparing mastectomy to the same level as total mastectomy given that its medical benefits are psychological?
It depends on your insurance. The major cost is for the time and effort of the plastic surgeon.
So, if your insurance would pay for a second surgeon to perform an immediate or delayed reconstruction, it does not make a difference whether or not the underlying operation is a simple mastectomy, a modified radical mastectomy, or a skin sparing mastectomy.Andrew Gonzalez, MD, JD, MPH Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.