Our Summary

This research paper discusses two modern surgical methods for treating breast cancer: skin-sparing mastectomies (SSM) and nipple-sparing mastectomies (NSM). SSM involves keeping most of the breast skin to aid in immediate breast reconstruction after removing the cancerous tissue. NSM is similar to SSM, but the nipple and surrounding area (nipple-areola complex or NAC) are also kept.

According to various studies, both SSM and NSM have similar outcomes to traditional, more invasive mastectomies, with low rates of cancer recurrence in the nipple area for NSM. Patients are generally very satisfied with NSM, and it seems to have positive psychological benefits.

These surgical methods are recommended for breast cancer or DCIS (a non-invasive type of breast cancer) cases that require mastectomy, including after chemotherapy. NSM can also be done for women who choose to have their breasts removed to reduce their risk of getting breast cancer.

To be eligible for NSM, it’s generally recommended that the tumor be at least 2 cm away from the nipple area. However, the most important factor is that there’s no sign of cancer in the nipple, which is checked during surgery. If cancer is found in the nipple, it cannot be preserved. Other reasons to avoid keeping the nipple include tiny calcium deposits near the nipple region and a nipple discharge that tests positive for cancer.

Both SSM and NSM have similar rates of complications to other post-mastectomy reconstruction methods. The main risk with NSM is that the preserved nipple area might die off, but this becomes less common as surgeons gain more experience with the procedure. Other factors that could increase the risk of complications include having large breasts, sagging breasts, being a smoker, being obese, and having received radiotherapy.

Because the surgical cut is small, it’s possible that some breast tissue might be left behind during these procedures. Therefore, only experienced breast surgeons should perform these operations, and they should work closely with a plastic surgeon. The researchers conclude that for patients who need a mastectomy, NSM should be the preferred option.

FAQs

  1. What are skin-sparing and nipple-sparing mastectomies and how do they differ from non-conservative mastectomies?
  2. What are the criteria for a patient to be considered for a nipple-sparing mastectomy?
  3. What are the potential complications of nipple-sparing mastectomy and what factors increase the risk of these complications?

Doctor’s Tip

A doctor might tell a patient undergoing mastectomy to consider skin-sparing or nipple-sparing mastectomy as conservative surgical approaches that can help achieve a quality cosmetic outcome. It is important to discuss with your surgeon the options available and the potential benefits and risks associated with each type of mastectomy. Additionally, factors such as tumor location and size should be taken into consideration when determining the most suitable surgical approach for your individual case. It is also important to follow post-operative care instructions and attend follow-up appointments to monitor for any potential complications.

Suitable For

Patients who are typically recommended for mastectomy include those with carcinoma or ductal carcinoma in situ (DCIS) that require mastectomy, including those who have undergone neoadjuvant chemotherapy. Additionally, women undergoing risk-reducing bilateral mastectomy may also be suitable candidates for mastectomy. It is important for the tumor to be at least 2 cm away from the nipple-areola complex (NAC), and there should be no evidence of nipple involvement on mandatory intraoperative nipple margin assessment. Patients with microcalcifications close to the subareolar region or a positive nipple discharge may not be suitable candidates for mastectomy with nipple preservation. Other factors that may affect candidacy for mastectomy include breast size, ptosis, smoking, obesity, and the need for radiotherapy. It is important for mastectomy procedures, especially nipple-sparing mastectomy, to be performed by experienced breast surgeons in collaboration with plastic surgeons to ensure optimal outcomes.

Timeline

  • Patient is diagnosed with breast cancer and undergoes imaging and biopsy to confirm diagnosis
  • Patient meets with surgical oncologist to discuss treatment options, including mastectomy
  • Patient undergoes pre-operative tests and evaluations to ensure they are a good candidate for surgery
  • Patient schedules surgery and prepares for the procedure
  • Patient undergoes mastectomy, either skin-sparing or nipple-sparing, with immediate breast reconstruction if desired
  • Patient recovers in the hospital for a few days and then continues recovery at home
  • Patient may experience physical and emotional challenges during the recovery period
  • Patient follows up with surgical oncologist for post-operative care and monitoring
  • Patient may undergo additional treatments such as chemotherapy or radiation therapy as part of their overall breast cancer treatment plan
  • Patient may undergo nipple reconstruction or other cosmetic procedures to enhance the appearance of the reconstructed breast
  • Patient continues with long-term follow-up care to monitor for any signs of recurrence and to address any ongoing concerns or issues related to their mastectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about mastectomy include:

  1. What are the different types of mastectomy procedures available, and which one is most suitable for my situation?
  2. What are the potential risks and complications associated with mastectomy surgery?
  3. How will mastectomy impact my physical appearance and overall quality of life?
  4. Will I be able to undergo breast reconstruction immediately after mastectomy, and what are the available options?
  5. How long is the recovery period following mastectomy, and what can I expect in terms of post-operative care and follow-up appointments?
  6. What are the chances of cancer recurrence after mastectomy, and how will this be monitored?
  7. Are there any specific lifestyle changes or precautions I should take following mastectomy?
  8. How will mastectomy impact my emotional well-being and mental health, and are there any resources or support groups available for patients undergoing this procedure?
  9. What are the success rates and patient satisfaction outcomes for skin-sparing and nipple-sparing mastectomies compared to traditional mastectomy procedures?
  10. Can you provide me with more information about your experience and expertise in performing mastectomy surgeries, particularly skin-sparing and nipple-sparing techniques?

Reference

Authors: Galimberti V, Vicini E, Corso G, Morigi C, Fontana S, Sacchini V, Veronesi P. Journal: Breast. 2017 Aug;34 Suppl 1(Suppl 1):S82-S84. doi: 10.1016/j.breast.2017.06.034. Epub 2017 Jun 30. PMID: 28673535