Breast Cancer

Skin-Sparing Mastectomy

A skin-sparing mastectomy involves removal of the entire breast, nipple and areola without removal of the breast skin. It is commonly performed when an immediate breast reconstruction is performed during the same surgery. A skin-sparing mastectomy, with reconstruction, takes 2 to 8 hours. The variation in the length of surgery depends on what type of reconstruction is performed. A hospital stay after skin-sparing mastectomy and reconstruction may be 1 to 4 nights, depending on the type of reconstruction performed.

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 centers generally have more experience with this surgery. If an axillary dissection or a sentinel lymph node biopsy is necessary, 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-sized suction device. Patients are instructed in the care and monitoring of the drain and drainage until the drains are removed several days after surgery. Although some women find this bothersome, it's usually not painful.

The pain level following skin-sparing mastectomy is generally greater than for a simple (or total) 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. A sensation of numbness can occur under the arm, which usually happens only if an axillary dissection is performed. Some of this numbness may fade over time.

Fatigue is to be expected following the surgery. In addition to the emotionally draining experience of facing cancer surgery, the surgery is physically taxing as well. Patients are advised to plan a lighter schedule, with the possibility of daily naps, for the weeks following the surgery.