Mastectomy techniques have evolved considerably along with the development of breast reconstruction. Surgeons now have several approaches at their disposal. Factors like breast size, skin quality, symmetry, tumor location, desired breast size, and pre-existing scars all influence which method best suits a given patient.
Mastectomy design and quality impact breast reconstruction options and results. A mastectomy approach should be carefully tailored to the individual patient and the type of reconstruction they hope to have.
Patients considering reconstruction should make sure that their breast surgeon is in contact with their plastic surgeon during this process. The two doctors can and should work together to determine which type of mastectomy best suits your case and goals.
Surgeons place a final breast implant at the time of mastectomy.
Large studies on oncologic outcomes after skin-sparing mastectomy suggest that this approach is just as effective as traditional mastectomy in clearing breast cancer. Reconstruction after skin-sparing mastectomy can be based on implants or the patient’s own tissue (autologous). Nipple-areola reconstruction takes place at a second stage, depending on patient wishes.
In the past, nipple-sparing procedures showed an increased risk of cancer recurrence when compared to traditional mastectomies. However, more recent studies have defined criteria that appropriately identify patients in whom cancer in the nipple without any additional symptoms is highly unlikely. These patients may be candidates for nipple-sparing mastectomy.
Breast surgeons may consider a nipple-sparing technique for patients with a tumor that is sufficiently small (typically less than 3-4 cm) and far (at least 2-4 cm) from the nipple. This approach is also appropriate for patients undergoing risk-reducing mastectomies.
Implant and autologous reconstruction options are both available after nipple-sparing mastectomy. While nipple-areola reconstruction is not necessary, patients may choose a second stage surgery to refine the reconstruction.
An areola-sparing mastectomy is best suited for patients with favorable breast skin (no excessive ptosis or skin redundancy) who are candidates for autologous breast reconstruction.
If an implant reconstruction is utilized with a areola-sparing mastectomy, the nipple can later be reconstructed using the skin of the areola for the nipple mound.
This allows the removal of any excess skin in a manner that results in a more favorable shape of the reconstructed breast. Also, this approach may result in a less conspicuous scar as compared to a standard mastectomy approach.