If surgery to rebuild the breast will happen later, more breast skin will be removed. Introduced in the early 1990s, the skinsparing mastectomy removes the nippleareolar complex, skin overlying superficial tumors, previous surgical biopsy sites, and the entire breast parenchyma. In 1991 toth and lappert first described the term skin sparing mastectomy ssm, which is a technique used to extirpate the breast tissue with preservation of as much skin as possible, leaving behind an adequate skin envelope along with the infra mammary fold for optimum immediate breast reconstruction. A technique called sentinel lymph node biopsy is performed to be sure that the cancer has not spread to the lymph nodes. A mastectomy is a surgical procedure that removes one or both breasts, usually to treat or prevent breast cancer. The surgeon removes the breast tissue, nipple, and areola but leaves much of the skin intact. At the university of texas, md anderson cancer center, the skin sparing mastectomy technique ie, maximum preservation of breast skin with removal of only the nippleareola complex and the tumor. Whether you want to learn french, do some reading on biomedical technology and devices, or read a couple of selfimprovement books, then this category is for you. Nipplesparing mastectomy the traditional mastectomy procedure involves surgical removal of the breast glandular tissue as well as removal of the central breast skin. This will make sure the scar and chest surface are flat. This surgery typically includes the removal of both the nipple and areola, but the surgery can be performed using skin and nipple sparing techniques.
Risk factors for complications after skinsparing and nipple. Immediate reconstruction after nsm may allow for a better cosmetic. However, we do believe that it is a procedure that warrants serious consideration when mastectomy. Post operative photos of a patient who has undertaken a right skin sparing mastectomy and immediate reconstruction of the breast using an acellular dermal matrix and implant, as well as having a left breast enhancement at the same operation july 2015. With a skin sparing, nipple sparing mastectomy, which shape. Because of this, ssm has become increasingly more common in recent years and the inclusion criteria have also been expanded. Types of mastectomy breast surgery verywell health. Oncological considerations of skinsparing mastectomy. These reports led to the start of an interesting discussion on the improvement of cosmetic results and parallel doubts regarding local disease control. These are marked preoperatively, the skin is incised with a scalpel, and flaps are raised with either scalpel or electrocautery. Current strategies for minimizing complications of nipplesparing mastectomy are discussed including incision.
Dec 17, 2014 from a surgical perspective, there is a clear compromise between completeness of excision of atrisk ducts and likelihood of damaging the blood supply of the skin and nipple. Aperiareolarincisionortypeissm is commonly used in prophylactic cases and. Careful patient selection and choice of skin incisions are. During skin sparing mastectomy, the surgeon removes only the skin of the nipple. Operative approaches to nipplesparing mastectomy indications. Skin sparing mastectomy ssm is a new technique being used in a variety of clinical settings.
Oncologic safety of skinsparing and nipplesparing mastectomy. It would be fair to say that it is still investigational. A skin sparing mastectomy involves removal of all the breast tissue, nipple and areola, but not the breast skin. This is a confusing term in that only the skin overlying the nipple proper has been retained.
Skinsparing mastectomy and immediate breast reconstruction. Anatomy for skin sparing mastectomy from a surgical perspective, there is a clear compromise between completeness of excision of atrisk ducts and likelihood of damaging the blood supply of the skin and nipple. The use of nipplesparing mastectomy for prophylactic and therapeutic purposes has increased in recent years primarily driven by patient desire for improved esthetics. In most, but not all cases, the nipple and areola are also removed the surgeon closes the skin with stitches and puts in 12 tubes surgical drains so fluid from the wound can drain out see. The procedure has gained wide acceptance and has undergone numerous technical advances since its introduction over twenty years ago. Skinsparing mastectomy ssm is a new technique being used in a variety of clinical settings. Patients and methods between 1994 and 2000, 286 selected patients with an indication for mrm and tumor margins of greater than 2 cm from the nipple were presented with the alternative of a ssm.
Skinsparing mastectomy refers to the maximum preservation of the patients own breast skin with removal of only the nippleareola complex and any skin involved with or close to the tumor. Skin sparing mastectomy was first described by toth and lappert in the literature in 1991. Other variations in terminology or technique include skinsparing. Thus skinsparing mastectomy requires careful surgical technique, as. A surgeon will make an incision all the way around the nipple and will typically extend the incision horizontally across the breast as well. For many women diagnosed with breast cancer, the only surgical option is mastectomy. A major advance in oncologic breast surgery has been the development of skinsparing techniques. Introduction breastconserving surgery with adjuvant radiotherapy is a safe alternative to mastectomy for the majority of women with early breast cancer bc 1.
Depending on the location and size of the cancer or your preferences, it may involve the removal of your nipples or lymph nodes in your underarm area, though nipplesparing mastectomies are becoming increasingly common. By doing this, it makes the breast reconstruction easier while making it so there is less scarring on the breast. In a skinsparing mastectomy, the breast tissue is removed while most of the healthy breast skin is left. However, up to one third of patients require a mastectomy for large or. Losing the girls my journey through nipplesparing mastectomy and beyond breast cancer series book 1 ebook. Depending on the location and size of the cancer or your preferences, it may involve the removal of your nipples or lymph nodes in your underarm area, though nipple sparing mastectomies are becoming increasingly common. Skin sparing mastectomy can be performed as a simple or total mastectomy or as a modified radical mastectomy to provide the skin needed for immediate reconstruction. If fluid accumulates under skin after drain is removed, you will need to come back into office to let your physician drain the fluid. However, we do believe that it is a procedure that warrants serious consideration when mastectomy is needed to treat cancer or desired for risk reduction. Skin reducing mastectomy is a singlestage technique that helps us to overcome the cosmetic inadequacy of a type iv wise pattern skin sparing mastectomy final tinverted scar in heavy and.
In a technique called skin sparing mastectomy, much of your skin can be preserved. Apr 11, 2016 the use of nipple sparing mastectomy for prophylactic and therapeutic purposes has increased in recent years primarily driven by patient desire for improved esthetics. During most simple or modified radical mastectomies, the breast, overlying skin, areola, and nipple are removed. Skin sparing mastectomy was developed to minimize the deformity that results following removal of breast tissue for treatment of breast cancer. Breast reconstruction can be performed immediately after the mastectomy. Comparison of skinsparing mastectomy using ligasure. The type of skin sparing mastectomy has been classi. Nipplesparing mastectomy spares a portion of the skin including the nac. Mature data has confirmed its oncological safety in the treatment of breast cancer. Objective is skinsparing mastectomy ssm with conservation of the nippleareola complex nac and immediate autologous reconstruction as safe in oncologic terms as ssm with resection of the nac as modified radical mastectomy mrm summary background data the originally described technique of ssm included the removal of gland, nac, and biopsy scar. Skinsparing mastectomy ssm has emerged as an oncologically safe approach to earlystage breast cancer and prophylactic mastectomies. In a skin sparing mastectomy, all of the breast tissue is removed, the nipple is removed, but the skin is preserved. Nipplesparing mastectomy nsm, or subcutaneous mastectomy, combines a skinsparing mastectomy with preservation of the nippleareola complex nac, with the possibility of intraoperative pathological assessment of adjacent tissue.
Jun, 2016 the term total skin sparing mastectomy tssm was described by margulies et al. Chapter 11 nipplesparing mastectomy and reconstruction. With a skin sparing, nipple sparing mastectomy, which shape implant would be better. Skinsparing mastectomy with conservation of the nipple. This method is used only if the patient will have immediate breast reconstruction. Since the skin is not part of the glandular breast tissue itself but rather an envelope around the breast tissue, the idea of preserving the skin envelope led to the development of skinsparing mastectomy ssm. Skinsparing mastectomy was developed to minimize the deformity that results following removal of breast tissue for treatment of breast cancer. Skinsparing mastectomy ssm, including nipplesparing mastectomy nsm, has emerged as an alternative to standard mastectomy and is known to be oncologically safe, with improved cosmetic results and quality of life for patients with breast cancer 1,2,3. Skin sparing mastectomy refers to the maximum preservation of the patients own breast skin with removal of only the nippleareola complex and any skin involved with or close to the tumor. Anatomy for skinsparing mastectomy from a surgical perspective, there is a clear compromise between completeness of excision of atrisk ducts and likelihood of damaging the blood supply of the skin and nipple.
B pink highlighted area indicates tissue removed at mastectomy. In june 1991, toth and lappert first used the term skinsparing mastectomy for immediate reconstruction, and around the same time, kroll et al. The first report of nipplesparing mastectomy nsm came from hinton et. Skinsparing mastectomy can be performed as a simple or total mastectomy or as a modified radical mastectomy to provide the skin needed for immediate reconstruction. We compared the differences between use of electrocautery and ligasure small jaw in patients with breast cancer who underwent ssm. The technique of total skin sparing mastectomy tssm is differentiated from subcutaneous mastectomy in that minimal, if any, nipple. If you choose to have a prosthesis, you will be given a prescription to be fitted usually 4 to 6 weeks from the time of your mastectomy. This is done in conjunction with immediate reconstruction with a. Removal of a significant portion of breast skin can result in a prominent scar across the central breast and can make breast reconstruction more challenging. Jul 14, 2017 skinsparing mastectomy ssm is increasingly used in patients with breast cancer. Regarding the rate of side effects, the nac necrosis and the loss of skin sensitivity in that area are the most frequent events, but they should be compared with the total absence of nac of the standard approach, so the impact on patients quality of life of the nipplesparing mastectomy seems absolutely better whenever the technique is feasible. We call conservative mastectomy an innovative surgical approach that spares the nippleareola complex nac while removing the entire breast gland.
During skinsparing mastectomy, the surgeon removes only the skin of the nipple. In 1991 toth and lappert first described the term skinsparing mastectomy ssm, which is a technique used to extirpate the breast tissue with preservation of as much skin as possible, leaving behind an adequate skin envelope along with the infra mammary fold for optimum immediate breast reconstruction. Nipplesparing, or total skinsparing, mastectomy techniques entail complete removal of all breast tissue with excision of the nipple tissue while preserving the entire skin envelope. Skin sparing mastectomy techniques have been shown to be safe and result in better cosmetic results. In a skin sparing mastectomy, the breast tissue is removed while most of the healthy breast skin is left. Through nipplesparing mastectomy and beyond shirley alarie on amazon.
A skin sparing mastectomy is a procedure for the treatment of breast cancer. Thus skinsparing mastectomy requires careful surgical technique, as described in subsequent chapters on skinsparing and skinreducing mastectomy. Nipple sparing mastectomy is currently being performed at highvolume breast centers throughout the country. Two generations ago, skin muscle, nipple and all the surrounding lymph nodes were removed at the sign of breast cancer and this resulted in a cure. Comparison of skinsparing mastectomy using ligasure small. This animation shows and describes this advanced surgical procedure, which preserves the skin during the removal of one or both breasts, allowing for a better breast reconstruction result. This will leave a medium to large sized scar on the front of. Despite the lack of randomised controlled trials, ssm. Totalsimple mastectomy 46 modified radical mastectomy 48 skin sparing mastectomy 49 nipple sparing mastectomy 50 axillary lymph node dissection 56 breast reconstruction general information on breast reconstruction 63 immediate or delayed 64 implant 64 natural tissue 65 nippleareola reconstruction 69. During the surgery, the surgeon preserves all of the breast skin except for the nipple and areola. Since the skin is not part of the glandular breast tissue itself but rather an envelope around the breast tissue, the idea of preserving the skin envelope led to the development of skin sparing mastectomy ssm. A skin sparing mastectomy may not be suitable for larger tumors. The book is targeted at general surgeons, dedicated breast surgeons, and plastic.
Nipple sparing mastectomy minimally invasive videoassisted. From a surgical perspective, there is a clear compromise between completeness of excision of atrisk ducts and likelihood of damaging the blood supply of the skin and nipple. In a technique called skinsparing mastectomy, much of. In this study we demonstrate the feasibility and safety of type i skin. Nipplesparing mastectomy has low rate of breast cancer. The categories of this book varies from anatomy to preoperative evaluation, surgical approaches, and the stateofart breast reconstructive technologies in a systematic fashion. Other authors describe the procedure as nipplesparing mastectomy.
Sep 19, 2018 skin sparing mastectomy is a technique that preserves as much of the breast skin as possible. Nipple sparing mastectomy nsm has quickly become an accepted technique for patients with selected cancers and for risk reducing surgery. Toth and lappert 1 described a skinsparing mastectomy in 1991. Skin reduction mastectomy with reconstruction textbook. Aperiareolarincisionortypeissm is commonly used in prophylactic cases and for nonpalpable. Implantbased dualplane reconstruction of the breast following. The answer to this question really depends on the size and shape of your present breast.
Feb 11, 2019 a study by alhimdani et al comparing patient characteristics and outcomes between individuals who underwent skin sparing mastectomy ssm and those treated with simple mastectomy found that the 8year local breast cancer recurrence rates for ssm versus simple mastectomy were 7. Other authors describe the procedure as nipple sparing mastectomy. These reports led to the start of an interesting discussion on the improvement of cosmetic results and parallel doubts. May 15, 2017 during most simple or modified radical mastectomies, the breast, overlying skin, areola, and nipple are removed. Skinreducing mastectomy is a singlestage technique that helps us to overcome the cosmetic inadequacy of a type iv wise pattern skinsparing mastectomy final tinverted scar in heavy and. Nipple sparing, or total skin sparing, mastectomy techniques entail complete removal of all breast tissue with excision of the nipple tissue while preserving the entire skin envelope.
Skin sparing mastectomy ssm has emerged as an oncologically safe approach to earlystage breast cancer and prophylactic mastectomies. Skin reduction mastectomy with reconstruction textbook of. Skin sparing mastectomy has resulted in marked improvement in the aesthetic results of immediate breast reconstruction. A modified radical mastectomy is a type of mastectomy that combines the removal of all breast tissue from the affected breast with lymph node removal from the armpit on the affected side of the body. This book describes in detail three different techniques for minimally invasive videoassisted breast surgery. Options after a skinsparing mastectomy ucsf health. Immediate breast reconstruction using acellular dermal. A mastectomy is a surgical procedure involving removal of all or part of the. Skinsparing mastectomy was first described by toth and lappert in the literature in 1991. Find information about coronavirus and breast cancer surgery a mastectomy is performed under general anesthesia. The inframammary approach to nipplesparing mastectomy. Scott l spear, catherine m hannan, in oncoplastic surgery of the breast, 2009.
By sparing the nac, we can ensure a much better cosmetic result, and in some cases we can also reduce the sensitive loss in this area. The flaps are developed just outside the envelope of. Nevertheless the ideal procedure is still far from being found. Shirley alarie shares her story to boost awareness of this specialized procedure. Nipple sparing mastectomy before and after bedford. Thus skin sparing mastectomy requires careful surgical technique, as described in subsequent chapters on skin sparing and skin reducing mastectomy. Traction is maintained on the breast with the nondominant hand, and even, upward countertraction is applied to the skin flaps. At johns hopkins, the skin sparing mastectomy is the most common type of mastectomy surgery performed for breast cancer treatment. Subcutaneous mastectomy an overview sciencedirect topics. This procedure requires one surgery and a second, very minor one, if you.
This study was presented in part in april 2016 at the american society of breast surgeons annual meeting in dallas. Between january 2012 and december 2015, 81 patients with breast cancer who underwent ssm were selected and were divided into the electrocautery group and the ligasure small jaw. The maximal amount of uninvolved skin is preserved, reducing or. In others, the risk of developing breast cancer is. Skinsparing mastectomy in a skinsparing mastectomy, the nipple and areola are usually removed, but the rest of the skin over the breast is preserved. Mastectomy is one of the most frequently performed breast operations, and with novel surgical techniques, preservation of the skin envelope. Skinsparing mastectomy is a technique that preserves as much of the breast skin as possible.
The term total skinsparing mastectomy tssm was described by margulies et al. Learn more about skinsparing mastectomy and breastconserving surgery. Thus skin sparing mastectomy requires careful surgical technique, as described in subsequent chapters on. I my practice, for most nipple sparing mastectomy patients, i usually. Not all patients who require a mastectomy are suitable for a skin sparing approach. Skin sparing mastectomy is a surgery where the breast tissue is removed while saving the skin of the breast. The technique of total skinsparing mastectomy tssm is differentiated from subcutaneous mastectomy in that minimal, if any, nipple.
Outcomes after total skinsparing mastectomy and immediate. At the university of texas, md anderson cancer center, the skinsparing mastectomy technique ie, maximum preservation of breast skin with removal of. Furthermore, the evidence concerning rt in relation to ssm and the possibility of nipple preservation was considered. Feb 03, 2015 in june 1991, toth and lappert first used the term skinsparing mastectomy for immediate reconstruction, and around the same time, kroll et al. Nipplesparing mastectomy is currently being performed at highvolume breast centers throughout the country. In contrast, delayed reconstruction requires the skin left after mastectomy to be stitched up. Oncologic safety of nipple sparing mastectomy in women with breast cancer, journal of the american college of surgeons. However, the risk of tumor involvement of nac in patients with breast cancer has been overestimated. In a skinsparing mastectomy, all the breast skin except the nipple and the areola is. Facs designates that a surgeon is a fellow of the american college of surgeons. Current strategies for minimizing complications of nipple sparing mastectomy are discussed including incision.
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