Skin-Sparing Mastectomy

A skin-sparing mastectomy is surgery that removes all your breast tissue but preserves as much of your skin as possible. Your healthcare provider can use this skin to rebuild your breast right away. Keeping your skin in place can help maintain a natural look and feel to your breast after surgery.

In a skin-sparing mastectomy, your surgeon will usually remove your nipple and areola. This is done to ensure they remove all the cancer if it’s close to or involves your nipple. The size and shape of your breast and blood supply to your nipple can also affect whether your surgeon can safely preserve it.

In some cases, you may be able to spare your nipple and areola. This is called a nipple-sparing mastectomy.

If you need breast cancer surgery, your provider will talk to you about all your options. To figure out which kind of mastectomy is right for you, they’ll consider factors like:

• The cancer stage
• The location of the tumor and whether it affects your nipple
• Your breast size
• The size of the tumor compared to the size of your breast
• Your overall health and healing risks
• Your reconstruction options and cosmetic goals

It’s completely normal to feel nervous or have questions about a skin-sparing mastectomy. Your care team will be there to provide answers and support you through each step.

Who is a candidate for skin-sparing mastectomy?

A skin-sparing mastectomy may be a good option if:

• You have early-stage breast cancer (stage I or II)
• The cancer doesn’t involve your skin (it’s confined to your breast tissue)
• The tumor can be safely removed while keeping most of your breast skin
• You plan to have immediate breast reconstruction

It’s not an option if you:

• Have inflammatory breast cancer or cancer that has spread to — or is very near — your skin
• Have large tumors close to the surface of your breast
• Don’t plan to have immediate reconstruction
• Have medical conditions that may slow wound healing or increase complications after surgery

How should I prepare for this procedure?

Before a skin-sparing mastectomy, your surgical team will make sure your body is ready, and you understand the procedure. You’ll have a physical exam, which may include blood and imaging tests. If you plan to have immediate breast reconstruction, you’ll also meet with a plastic surgeon to review your options.

To prepare for surgery, you may need to:

• Stop taking certain medications, like blood thinners
• Quit smoking or vaping, which can slow down the healing process
• Manage long-term (chronic) conditions like diabetes to reduce the risk of complications
• Fast (not eat or drink anything) for a certain amount of time before surgery
• Shower with antiseptic soap to reduce infection risk
• Arrange for someone to drive you home and help during the first few days of recovery

Your surgical team will also guide you on what to expect during your hospital stay and recovery. They’ll answer your questions ahead of time to help reduce anxiety and make the process smoother.

What happens during this procedure?

First, you’ll receive general anesthesia. That means you’ll be asleep and pain-free during the surgery.

Then, a surgical oncologist will:

1. Make a cut (incision). This is usually around your nipple, areola or another planned location, chosen to safely remove the cancer and allow for reconstruction.
2. Remove all the breast tissue, nipple and areola. But they’ll preserve the skin of your breast.
3. Work with a plastic surgeon to begin breast reconstruction right away. They’ll either use an implant or tissue graft from another part of your body. Your preserved skin (skin flap) acts like a natural envelope to shape your new breast.
4. Place one or more drains in the surgical site to prevent fluid buildup and reduce swelling during healing.
5. Close the incision with stitches.
6. Cover it with dressing. Or they’ll bandage and place a supportive surgical bra.

How long does this procedure take?

A skin-sparing mastectomy is typically performed with immediate breast reconstruction. The entire surgery usually takes four to eight hours.

The exact time depends on:

• Your surgical team
• How complex the procedure is
• The size and shape of your breast
• The type of reconstruction
• Whether you need additional procedures, like sentinel lymph node biopsy (lymph node removal)

What are the potential benefits and risks of this procedure?

Potential benefits of a skin-sparing mastectomy include:

• Improved cosmetic outcomes: It preserves most of your breast skin. This helps create a more natural shape and appearance after reconstruction.
• Immediate reconstruction: Breast reconstruction is typically performed during the same operation.
• Fewer major reconstructive procedures: Sparing your skin may reduce the need for additional major procedures. You may still need minor revision surgeries or nipple reconstruction.
• Better symmetry: Preserved skin can help your new breast more closely match the other one.
• Safe for early breast cancer: It has the same risk of breast cancer coming back as other types of mastectomies.

Potential risks of a skin-sparing mastectomy include:

• Infection: As with any surgery, there’s a risk of infection.
• Bleeding or hematoma: Blood may collect under your skin, which will need treatment.
• Need for more procedures: If complications occur, you may require additional surgery.
• Skin flap problems: Sometimes, the preserved skin doesn’t heal well. This can lead to skin necrosis (death).
• Not appropriate for all cancers: This surgery may not be safe for inflammatory breast cancer, some advanced-stage cancers or if the cancer involves your skin.

What happens after this procedure?

After surgery, you’ll go to a recovery area. Nurses and other healthcare providers will closely watch your vital signs as you wake up from anesthesia. You’ll get medication to manage the pain. First, it’ll be through an IV or a pain pump. Once you’re fully awake, you can take pain medication by mouth.

Your care team will regularly check your skin flaps and reconstructed breasts. This is to ensure proper blood flow, normal color and appropriate swelling.

You’ll start with IV fluids and gradually return to drinking and eating as tolerated. You’ll be encouraged to begin gentle arm movements to prevent stiffness. But you should avoid heavy lifting or stretching.

You’ll receive specific instructions about physical activity and arm movement. Your provider will let you know about any activity restrictions to support healing and recovery.

Hospital stays vary after surgery. You may go home the same day, or you may stay in the hospital for one to three days. It depends on the extent of reconstruction, your overall health and how well your recovery is going.

Skin-sparing mastectomy recovery

During your first two weeks at home, you’ll need to empty and care for your surgical drains. You’ll also need to keep your bandage clean and dry. Your care team will give you detailed instructions before you leave the hospital.

You may still feel some pain, tightness or soreness in your chest and underarm areas. If your healthcare provider prescribed pain medicine, take it as directed. Don’t skip doses. If they prescribed antibiotics, complete the full course to help prevent infection.

Some swelling, bruising or tingling around your chest and underarm is normal. Wearing a supportive surgical bra can reduce discomfort and swelling.

You’ll receive instructions on physical activity and movement. Gentle arm and shoulder movement is encouraged to prevent stiffness. It also reduces the risk of developing a condition called cording. Avoid heavy lifting, pushing or pulling for at least two to three weeks. Walking and other light physical activity are encouraged to improve circulation and prevent blood clots.

You’ll have a follow-up appointment with your provider about one to two weeks after surgery. They’ll check your healing and assess whether the drains are ready for removal. The timing of drain removal varies. It depends on your healing and drain output. Your provider will also discuss the timing of any additional treatments, like radiation or chemotherapy, if needed.

When should I call my healthcare provider?

Call your healthcare provider immediately if you notice:

• Increasing redness or skin discoloration around the incision
• Warmth, swelling or worsening pain at the surgical site
• Fever or chills
• Excessive bleeding, sudden increase in drainage or fluid leaking from the incision or drains
• Signs that the skin flap isn’t healing, like color changes or unusual firmness
• Foul-smelling drainage
• Drain problems — like a drain falling out, drainage stopping suddenly or a drain not holding suction
• Nausea or vomiting that won’t stop and prevents you from keeping fluids or medication down
• Separation of the incision edges or new skin breakdown

Go to the emergency room or call 911 (or your local emergency service number) immediately if you have chest pain that’s new, severe or different from discomfort you’d expect after surgery. Also, go if you have new or worsening shortness of breath.

Skin-sparing mastectomy vs. simple mastectomy

A skin-sparing mastectomy removes all the breast tissue, nipple and areola while preserving most of your skin. This makes it easier to rebuild your breast right away and often gives a more natural look.

A simple mastectomy removes all the breast tissue, nipple, areola and overlying skin. You may have a simple mastectomy if:

• The tumor involves your skin
• Your surgeon needs to remove additional skin
• You’re not planning immediate breast reconstruction