The skin sparing mastectomy has the advantage in that it
allows for a better primary breast reconstruction. From a practical point of view today, a skin sparing
mastectomy combined with DIEP flap reconstructive breast surgery can be done in many women with removal of
only the nipple areolar complex.
With DIEP flap breast reconstruction the nipple and areola are
reconstructed and the scar that is left
on the breast is the scar around the reconstructed areola.
Dr. Keller prefers to hide the
scar there because of the favorable color and texture differences in the skin.
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This patient has had bilateral skin sparing
mastectomies and DIEP flap reconstruction.
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The treatment of the biopsy incision has evolved which has
helped to make the skin sparing mastectomy a possibility for more patients
undergoing mastectomy. Improvements in technology and surgical techniques often
allow the biopsy to be done with a needle (No incision).
This avoids the discussion of whether the biopsy scar needs to be
excised. Circumareolar biopsy
incisions (a cut around the periphery of the areola) can be removed in the skin
sparing mastectomy excision. Lastly, some breast surgeons no longer feel that it
is necessary to excise the biopsy scar in all patients undergoing mastectomy.
The last piece of the puzzle is the axillary dissection
(lymph node sampling). An axillary
dissection can be done in some patients through the circumareolar mastectomy
incision. In others, a separate
incision hidden in the armpit is utilized.
Still other patients can best be served with a sentinel node biopsy
performed through a separate armpit incision.
This procedure is utilized in selected patients to avoid lymph node
dissection. (The primary node
(sentinel node) that drains the area where the cancer is in the breast is
removed and examined microscopically. The
assumption is made that if this node is free of cancer, all the other lymph
nodes would be also tumor free.)
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This 57 year old who 4 years ago underwent a right
lumpectomy and radiation therapy now presents with right breast
cancer and will undergo
bilateral mastectomies through a circumareolar skin sparing
incision. The previous lumpectomy site is seen on the right breast.
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Here she is post operatively. She had skin sparing mastectomies and bilateral
reconstruction.
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This 57 year old had a lumpectomy. radiation, and chemotherapy for a
right breast cancer 7 years ago. When she developed disease in
the left breast she underwent bilateral mastectomies and bilateral DIEP
flap reconstruction. While skin sparing mastectomies were not
possible, an excellent shape and contour was nevertheless obtained.
On an outpatient basis, she will undergo nipple areola
reconstruction.
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