This is what mastectomy has evolved to: removal of the entire breast, usually through an incision along the fold below a woman’s breast (inframammary fold) with preservation of all the skin and the nipple-areolar complex.
Technically this can be an extremely challenging operation, especially when the breasts are large. The “results” vary depending on the skill, experience and patience of the surgeon. What I mean by “results” in this context is:
As with the skin sparing mastectomy, this operation is done in combination with reconstruction, either implant based or autologous (tissue taken from the patient’s body).
The breast is separated from the subcutaneous fat everywhere except under the nipple. In this area, there is no subcutaneous fat, rather, the milk ducts come right up to the skin. So, the milk ducts need to be transected under the nipple and some breast tissue will be left behind. If too much ductal tissue is left behind, there is the risk of developing cancer. If too little ductal tissue remains, there is a risk the blood supply to the nipple will be lost and the nipple will die.
Because the entire skin envelope is spared, the cosmetic outcome with a SNSM and reconstruction can be outstanding. In fact, in many cases the patient looks better after surgery than before. Oftenthe reconstructed breast is lifted and fuller, giving it amore youthful appearance.
Skin and nipple sparing mastectomy is an option for women who are considering prophylactic(preventative) mastectomy because they are at high risk for developing breast cancer such as those with a BRCA mutation. Although some breast tissue remains posterior to the nipple areolar complex, the incidence of these high-risk patients developing breast cancer after a SNSM in this less than 5 percent.
Some patients with early stage breast cancer (stage 0, 1 and 2) who are not candidates for beast conservation may be considered for skin and nipple sparing mastectomy. However, the tumor must be at least 2 cm away from the nipple areolar complex. A preoperative MRI can be helpful to make this determination.
Patients with large breasts or those with significant ptosis (drooping or sagging) are not good candidates for this type of mastectomy and may be more suited for the skin sparing mastectomy.