Skin-sparing mastectomy explained | CION Cancer Clinics

A skin-sparing mastectomy removes all of the breast tissue and the nipple but keeps most of the breast skin. The surgeon works through a smaller opening, usually around the dark area of the nipple, and the kept skin is then filled with an implant or your own tissue to make a new breast shape.

Why keep the skin at all

The skin is what gives a breast its natural outline and fold. Keeping it means a new breast can be made in the same operation, with a smaller scar and a shape that often looks closer to the other side in clothes. Without reconstruction there is little reason to keep the skin, so the two usually go together.

Is it as thorough as a standard mastectomy?

The breast tissue under the skin is still removed. For suitable cancers, studies comparing it with a standard mastectomy have found the chance of the cancer returning in the chest is similar. That is only true when it suits the cancer, which is why careful selection matters.

What it does not decide

Whether you are offered it is your treating team's decision, made from your scans, biopsy report and examination. This page explains what they weigh. It cannot tell you whether it is right for you.

The problems are mostly those of any mastectomy, plus a few linked to keeping the skin and making a new shape. Your surgeon should explain how often they see each one.

Problems with the kept skin

Because the skin is thin, part of it can lose its blood supply and darken. Small patches usually heal with dressings. A larger area may need another operation and can affect an implant underneath. Smoking makes this much more likely.

Infection and fluid

Redness, heat and fever can mean infection, which is more serious when an implant is in place. Fluid can also collect under the skin after the drain comes out.

Numbness and shape

The kept skin is usually numb, and feeling may return only partly. The new breast may not match the other side exactly, and a second smaller operation to adjust the shape is common.

It cannot tell you whether you are suitable, what your new breast will look like, or how your skin will heal. Those depend on your cancer, your body and the surgeons treating you.

Questions to take to the appointment

Ask whether a skin-sparing operation is possible for you, and if not, why not. Ask which kind of reconstruction is suggested and what each involves. Ask whether radiotherapy is likely. Ask how often the team does this operation and whether a plastic surgeon will be involved.

When a second look is reasonable

If you have been told the skin cannot be kept and you want to understand why, asking another surgical oncologist to review the same scans and biopsy report is normal. A good surgeon will not be offended. Keep copies of every report so nothing needs repeating.