Skinsparing mastectomy and immediate reconstruction is an acceptable treatment option for patients with highrisk breast carcinoma. In a skinsparing mastectomy, the breast tissue is removed while most of the healthy breast skin is left. Skin sparing mastectomy ssm can be followed by immediate breast reconstruction ibr using autologous tissue andor prosthetic implants, and this approach has been advocated as an effective. Nipple sparing mastectomy nsm is a surgical advancement for women undergoing removal of the breast due to breast cancer or as a preventative measure known as risk reduction surgery. Nipplesparing, or total skinsparing, mastectomy techniques entail complete removal of all breast tissue with excision of the nipple tissue while pre. Immediate reconstruction after nsm may allow for a better cosmetic result for patients undergoing total mastectomy. A skinsparing mastectomy saves as much of the skin of the breast as possible. Introduction breastconserving surgery with adjuvant radiotherapy is a safe alternative to mastectomy for the majority of women with early breast cancer bc 1. Does immediate reconstruction complicate or modify the course of the disease. A total mastectomy, also known as a simple mastectomy, involves removal of the entire breast, including the breast tissue, areola and nipple. Skinsparing mastectomy and nipplesparing mastectomy. Performance and practice guidelines for mastectomy american. A surgeon will make an incision all the way around the nipple and will typically extend the incision horizontally across the breast as well.
Implants are usually placed as part of a twostage procedure. Aperiareolarincisionortypeissm is commonly used in prophylactic cases and. Skinsparing mastectomy mastektome is also called ssm or subcutaneous mastectomy. Oncologic safety of nipple skinsparing or total skinsparing.
Skinsparing mastectomy in breast cancer bmc cancer full text. Skin sparing mastectomy ssm and immediate breast reconstruction ibr have become popular as effective procedures for local control of cancer and postoperative aesthetic results of the breast in patients with early breast cancer. For most patients, skin sparing mastectomy is equally as effective at removing breast cancer as the more traditional mastectomy operation, which requires the removal of significantly more. The records of all patients who had undergone treatment of t1 or t2 breast cancer by. Apr 12, 2020 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. Most mastectomies are performed using a technique called skinsparing mastectomy, in which much of the breast skin is saved for use in reconstructing the breast. Skinsparing mastectomy in breast cancer bmc cancer.
Hypothesis dissection of subnipple tissue to spare the entire skin envelope of the breast total skinsparing mastectomy is a feasible option in appropriately selected patients and yields an excellent final cosmetic outcome. In a technique called skinsparing mastectomy, much of your skin can be preserved. Factors affecting postoperative complications following skin. The goals of breast cancer surgery are to remove all or most of the cancer, prevent its return, and avoid disfigurement as much as possible. Coding for nipplesparing and skinsparing mastectomies. Nipple sparing mastectomy is a variation of the skin sparing mastectomy. Skinsparing mastectomy ssm greatly enhances the aesthetic results of breast reconstruction, is not yet a standard technique for breast cancer treatment, although it is shown as an advanced and promising procedure. Surgical management of breast carcinoma has evolved to include more breast conserving techniques such as skin, nipple, and areola sparing mastectomies, as improved cosmesis becomes an increasing concern. The first report of nipplesparing mastectomy nsm came from hinton et al. This may be done to treat breast cancer tumor while leaving much of the skin that covers the breast. The advent of skinsparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. The type of skin sparing mastectomy has been classi.
The surgeon removes the breast tissue, nipple, and areola but leaves much of the skin intact. Thomas hospital, westminster bridge road, london se1 7eh, uk. Wisepattern skin reducing and nipplesparing mastectomy. Skin sparing mastectomy, combined with immediate breast reconstruction, has become increasingly popular.
Nipplesparing mastectomy nsm combines a skinsparing mastectomy with preservation of the nac, intraoperative pathological assessment of the nipple tissue core, and immediate reconstruction, thereby permitting better cosmesis for patients undergoing total mastectomy. A sentinel lymph node biopsy may be done at the time of a total mastectomy. Skinsparing mastectomy refers to the maximum preservation of the patients own breast skin with removal of only the nippleareola complex and. The goal of nsm is the preservation of structure and form of the breast. A nipplesparing mastectomy is a skinsparing mastectomy that also keeps the nipple and areola the darkly shaded circle of skin around the nipple intact. Nipplesparing mastectomy in breast cancer patients spandidos. A skinsparing mastectomy ssm is surgery to remove breast tissue and leave the skin over the breast. Complications, risk factors, and patientsreported outcomes after skinsparing mastectomy followed by breast reconstruction in women with brca mutations. Traditional skinsparing mastectomy which sacrifices the nippleareolar complex nac, can leave unsightly scarring across the breast mound. If you are having breast reconstruction at the same time as a mastectomy, the surgeon may be able to use a skin sparing technique, or possibly a nipple sparing technique. To demonstrate the feasibility and accessibility of performing adequate mastectomy to extirpate the breast tissue, along with enblock formal. Skinsparing mastectomy ssm was later introduced to optimize the cosmetic.
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. Distinctions between complete mastectomy and subcutaneous mastectomy a skinsparing or nipplesparing mastectomy for diagnosed. Mastectomy with reconstruction is typically done through an elliptical skin sparing incision, with the. The mastectomy scar is often visible within the social triangle or decolletage area of the breast. Further research is required to confirm oncologic safety in t3 tumors. Nipple sparing mastectomy may be regarded as the modern gold standard with respect to beautiful outcomes following complete mastectomy and immediate reconstruction. However, the surgery can be performed using skin and nipple sparing techniques.
Skin sparing ssm and nipple sparing nsm mastectomies are relatively new conservative surgical approaches to breast cancer. Risk factors for complications after skinsparing and nipple. The surgeon removes the entire breast along with the nipple and areola. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread. In 1991, skinsparing mastectomy ssm was first described by toth and lappert 2 with resecting the whole breast and. Optimizing the total skinsparing mastectomy breast.
This method is used only if the patient will have immediate breast reconstruction. Pdf skinsparing mastectomy and immediate reconstruction. What is a skinsparing mastectomy for breast cancer. Ssm is done to treat breast cancer and keep cancer from spreading. Nipple sparing mastectomy nsm combines a skin sparing mastectomy with preservation of the nac, intraoperative pathological assessment of the nipple tissue core, and immediate reconstruction, thereby permitting better cosmesis for patients undergoing total mastectomy. Mastectomy with reconstruction is typically done through an elliptical skinsparing incision, with the. The records of all patients who had undergone treatment of t1 or t2 breast cancer by mastectomy and. Mastectomy without reconstruction is typically done through an elliptical incision, encompassing the nippleareola, sufficient to allow sln biopsy or alnd, and removing enough skin that the skin flaps will lie flat without redundancy. Implants are inserted underneath the skin or chest muscle following the mastectomy. Aesthetic design of skinsparing mastectomy incisions for. 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. Skinsparing mastectomy facilitates immediate breast reconstruction by reducing remedial surgery on the opposite breast.
Original article factors affecting postoperative complications following skin sparing mastectomy with immediate breast reconstruction kerry davies, lyra allan, paul roblin, david ross, jian farhadi gkt cancer reconstructive service, st. 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. In a technique called skinsparing mastectomy, much of. If you are having breast reconstruction at the same time as a mastectomy, the surgeon may be able to use a skinsparing technique, or possibly a nipplesparing technique a skinsparing mastectomy removes all of the breast tissue, but saves much of the skin of the breast. Mastectomy with complete preservation of the skin envelope has been developed as an extension of skin sparing mastectomy to improve aesthetic and psychological outcomes for patients. In a skin sparing mastectomy, the breast tissue is removed while most of the healthy breast skin is left. Clinical outcomes after skinsparing or nipple areolar complex. The skinsparing mastectomy ssm in conservation first and. Most mastectomies are performed using a technique called skin sparing mastectomy, in which much of the breast skin is saved for use in reconstructing the breast.
In addition, this paper will discuss the oncologic importance of margin status and type of mastectomy as it pertains to risk of local recurrence and relative need for adjuvant therapy. Hypothesisthe rationale for removal of the nippleareolar complex nac during total mastectomy centers on longstanding concerns about possible neoplastic. Learn more about skinsparing mastectomy and breastconserving surgery. Sep 19, 2018 skin sparing mastectomy is a technique that preserves as much of the breast skin as possible. Gerber and colleagues5 were the first to describe the preservation of the nippleareola complex nac. Skin sparing mastectomy ssm greatly enhances the aesthetic results of breast reconstruction, is not yet a standard technique for breast cancer treatment, although it is shown as an advanced and promising procedure. A skin sparing mastectomy is a procedure for the treatment of breast cancer. Retrospective study of the skinsparing mastectomy in breast reconstruction. Skin sparing mastectomy facilitates immediate breast reconstruction by reducing remedial surgery on the opposite breast. A simple mastectomy, also known as a total mastectomy, is a procedure that removes all of the breast tissue of the affected breast. A skin sparing mastectomy removes all of the breast tissue, but saves much of the skin of the breast. Skinsparing mastectomy ssm can be followed by immediate breast reconstruction ibr using autologous tissue andor prosthetic implants, and this approach has been advocated as an effective. Breast reconstruction after mastectomy national cancer.
It may also include where you had a biopsy or where there is a tumor close to the skin. Ssm is a type of mastectomy which is surgery to remove the breast. Skin sparing mastectomy through a circumareolar incision has proven to be a safe and feasible option for the management of breast cancer in egyptian women, offering them adequate oncologic control and optimum cosmetic outcome through preservation of the skin envelope of the breast when ever indicated. By doing this, it makes the breast reconstruction easier while making it so there is less scarring on the breast. Four types of skin incisions for skinsparing mastectomy. Jan 26, 2020 during a skin sparing mastectomy, your surgeon removes the skin of the nipple and areola, and the area where the tumor was taken out, but leaves the rest of the skin so it can be used for your breast. Nipplesparing and skinsparing mastectomy the breast. Surgical treatment has presented dramatics changes. Four types of skin incisions for skinsparing mastectomy with. Halsteds radical mastectomy had been the standard of care for patients since its inception in 1894 up to the 1960s. The surgeon removes the breast with the nipple and areola with minimal skin removal. During skinsparing mastectomy, the surgeon removes only the skin of the nipple, areola, and the original biopsy scar. This discussion should include mastectomy vs bcs, the types of mastectomy conventional, skinsparing, nipple sparing, the options for reconstruction none. A skin sparing mastectomy saves as much of the skin of the breast as possible.
Native skin flap necrosis is not increased over that seen with nonssm. However, up to one third of patients require a mastectomy for large or. Mastectomia skin sparing ssmmastectomia skin sparing ssm definizione toth b, lappert p. Skin, nipple, and areolasparing mastectomy breast cancer. In a technique called skin sparing mastectomy, much of your skin can be preserved. Skinsparing mastectomy is a technique that preserves as much of the breast skin as possible. The plastic surgeon can use this skin to help form the reconstructed breast. As a result of these conceptual changes, the following new questions arose. During most simple or modified radical mastectomies, the breast, overlying skin, areola, and nipple are removed. Skin sparing mastectomies can be used in the treatment of invasive cancer without compromising local control. In selected cases, the nippleareola complex can be preserved. The breast tissue is removed, but the breast skin and nipple are left in place.
Our purpose was to evaluate the longterm oncologic risk of skin sparing mastectomy. Feb 03, 2020 skin sparing mastectomy mastektome is also called ssm or subcutaneous mastectomy. Skin sparring mastectomy and large breasts, what are my. Skinsparing mastectomy ssm and immediate breast reconstruction ibr have become popular as effective procedures for local control of cancer and postoperative aesthetic results of the breast in patients with early breast cancer.
Outcomes after total skinsparing mastectomy and immediate. Distinctions between complete mastectomy and subcutaneous mastectomy a skin sparing or nipple sparing mastectomy for diagnosed. A modified radical mastectomy is a procedure that removes the entire breast including the skin, breast tissue, areola, and nipple along with most of your underarm lymph nodes. Breast cancer treatment needs to be multidisciplinary. B pink highlighted area indicates tissue removed at mastectomy. Adm is a soft connective tissue graft generated via a decellularization process that preserves intact the extracellular skin matrix. At johns hopkins, the skin sparing mastectomy is the most common type of mastectomy surgery performed for breast cancer treatment. Skin, nipple, and areolasparing mastectomy volume 11 issue 12 e. Nipple sparing mastectomy is an extension of the more commonly known skinsparing mastectomy.
Skin sparing mastectomy is a surgery where the breast tissue is removed while saving the skin of the breast. Skin sparing mastectomy and nipple sparing mastectomy. Nipple sparing mastectomy nsm can be performed for prophylactic mastectomy and the treatment of selected breast cancer with. Skinsparing mastectomy aftercare instructions what you. Nipplesparing mastectomy is a variation of the skinsparing mastectomy. Patey described the modified radical mastectomy, which achieved a local recurrence rate of 10% after 10 years. 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. Local and distant recurrence rates in skinsparing mastectomies compared with nonskinsparing mastectomies.
This will make sure the scar and chest surface are flat. During the surgery, the surgeon preserves all of the breast skin except for the nipple and areola. In a skin sparing mastectomy, all of the breast tissue is removed, the nipple is removed, but the skin is preserved. Through a small incision, all of the breast glandular tissue is removed from beneath the overlying skin and nipple. If surgery to rebuild the breast will happen later, more breast skin will be removed. The surgeon often removes the breast tissue beneath the nipple and areola during the procedure to check for cancer cells.
Nipple sparing mastectomy what is nipple sparing mastectomy. Design prospective surgical technique outcomes study. Nipple sparing, or total skin sparing, mastectomy techniques entail complete removal of all breast tissue with excision of the nipple tissue while pre. Major complications included haematoma requiring surgeryand skin.
Jun 28, 2018 a modified radical mastectomy is a procedure that removes the entire breast including the skin, breast tissue, areola, and nipple along with most of your underarm lymph nodes. However, there are no published longterm data to support its oncologic safety. Simple, skin sparing and nipple sparing mastectomy is a surgery performed to remove the breast, usually to treat or prevent breast cancer. Factors affecting postoperative complications following. In the prepectoral plane, the implant could be wrapped or partially covered with a pocket approach, which is our preference fig. Only the nipple and areola dark circle around the nipple are removed.
Skinsparing mastectomy aftercare instructions what. The most common form of the surgery, referred to as traditional total mastectomy, includes the removal of the areola and nipple. Skinsparing mastectomy, combined with immediate breast reconstruction, has become increasingly popular. Skinsparing mastectomies can be used in the treatment of invasive cancer without compromising local control. Skinsparing mastectomy and immediate breast reconstruction. If you are considering mastectomy, my strong opinion is that you have the incision placed vertically and not horizontally. Skin sparing mastectomy the skin sparing mastectomy approach is an alternative to traditional mastectomy that aims to preserve most of the breast skin. What to expect during a mastectomy surgery susan g. Skinsparing mastectomy ssm was later introduced to optimize the cosmetic outcomes of smaller incisions and to preserve breast anatomy. Complications,which occurred in the immediate postoperative period 0e10 days, were classi. Skinsparing ssm and nipplesparing nsm mastectomies are relatively new conservative surgical approaches to breast cancer. A nipple sparing mastectomy is a skin sparing mastectomy that also keeps the nipple and areola the darkly shaded circle of skin around the nipple intact. In todays world where we know skin sparing is safe, there is never a reason to have a long horizontal mastectomy scar, except to reflect that your gen surg or ps cant think outside the box.
Skinsparing mastectomy inpatient care what you need. In ssm most of the breast skin is conserved to create a pocket that facilitates immediate breast reconstruction with implant or autologous graft to achieve a quality cosmetic outcome. Some coding consultants continue to direct surgeons and coders to incorrectly report 19304 for procedures that should be reported with 19303. May 15, 2017 during most simple or modified radical mastectomies, the breast, overlying skin, areola, and nipple are removed.