Skin-Sparing Mastectomy (SSM) Nipple-Sparing Mastectomy (NSM)

Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are surgical techniques for removing breast tissue while preserving as much skin as possible. These approaches are commonly used in patients undergoing breast cancer surgery with the goal of immediate or delayed reconstruction.

Indications

  • Skin-Sparing Mastectomy (SSM): Recommended for patients with early-stage breast cancer, ductal carcinoma in situ (DCIS), or as a risk-reducing procedure for those with a high genetic risk (e.g., BRCA mutation). The nipple-areolar complex (NAC) is removed.

  • Nipple-Sparing Mastectomy (NSM): Suitable for select patients with small, peripherally located tumours or undergoing prophylactic mastectomy. The nipple and surrounding skin are preserved if oncologically safe.

Surgical Technique

  • The procedure involves making incisions to remove breast tissue while preserving the skin envelope (and nipple in NSM).

  • The surgeon carefully evaluates tissue beneath the nipple to ensure no cancer remains.

  • Reconstruction is often performed immediately using implants or autologous (own body) tissue.

Reconstruction Options

  1. Prosthetic (Implant-Based Reconstruction)

    • Silicone implants placed beneath the chest muscle or above the muscle with a supportive mesh.

  2. Autologous (Flap) Reconstruction

    • Uses the patient's own tissue from areas like the abdomen (DIEP flap), back (latissimus dorsi flap), or thighs.

    • Provides a more natural appearance and feel but involves a longer operation & recovery period.

Post-Operative Care

  • Drains: Small surgical drains may be placed to remove excess fluid. These are typically removed within 1-2 weeks.

  • Pain Management: Pain medications and muscle relaxants may be prescribed.

  • Activity Restrictions: Avoid heavy lifting or strenuous activity for 4-6 weeks.

  • Wound Care: Keep incisions clean and dry; follow surgeon’s instructions on dressing changes.

Skin-sparing and nipple-sparing mastectomy are effective surgical options for breast cancer patients seeking optimal cosmetic outcomes. Your surgeon will discuss the best approach for your specific case, considering oncologic safety and reconstruction preferences.