Skin Sparing Mastectomy

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 breast reconstruction 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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Case Study

This patient has had bilateral skin sparing mastectomy 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 women undergoing mastectomy. Improvements in technology and surgical techniques often allow the biopsy to be done with a needle (requiring 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 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.)

Case Study

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 skin sparing mastectomy through a circumareolar incision. The previous lumpectomy site is seen on the right breast. She is also shown post operatively.

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The advantage of the skin sparing mastectomy is that it allows for a better primary breast reconstruction. The entire envelope of the new reconstructed breast is the breast skin. Only the nipple and areola need to be added after the initial procedure. Keep in mind that not all women are candidates for this procedure. It is the breast surgeon and not the plastic surgeon that has the final say. Dr. Keller discusses this with every patient.

To find out more about skin sparing mastectomy, read frequently asked questions or click here to request a phone consultation from Dr. Keller, a renowned plastic surgeon specializing in reconstructive flap procedures. You can also call the practice at 516-482-1100 to schedule an appointment.

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