Skin-sparing mastectomy

A skin-sparing mastectomy involves removal of the entire breast, including nipple and areola, without removal of the breast skin. It is commonly performed when a breast reconstruction is scheduled to occur during the same surgery. A skin-sparing mastectomy, with reconstruction, takes two to eight hours. The variation in the length of surgery depends on the type of reconstruction being performed. A hospital stay after skin-sparing mastectomy and reconstruction may be one to four nights, depending on the type of reconstruction.

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Instead of a large incision across half the chest, the surgeon makes a small incision around the areola that maintains the rest of the breast skin. This is done to optimize the result of the cosmetic reconstruction. Surgeons at large cancer centers generally have more experience with this surgery. If a sentinel node biopsy or axillary dissection is needed to evaluate or remove lymph nodes, a second incision will be made under the arm.

After the surgeon completes the skin-sparing mastectomy, one or two plastic tubes about the width of a pen are gently sewn into place to draw off fluids. The ends of these drains are attached to a pocket-size suction device. Patients are instructed in the care of the drain and monitoring of the fluids until the tubes are removed several days after surgery.

The pain level following skin-sparing mastectomy is generally greater than for a simple mastectomy. After a skin-sparing mastectomy with reconstruction it is common to use prescription pain medication for the first week or two after surgery and then an over-the-counter pain reliever as needed.

Women often experience numbness under the arm when they've also had an axillary dissection to check lymph nodes. Some of this numbness may fade over time.

Fatigue is to be expected following the surgery, which tends to be emotionally as well as physically taxing. Patients are advised to plan a lighter schedule for the weeks following the surgery.