Medico-legal Expert​​

     email:rick@ricklinforth.com 

​

​​

Skin Sparing Mastectomy (SSM) is a type of mastectomy that preserves all of the skin of the breast except for the nipple and areola.

SSM removes nearly all of the contents of the breast except for a thin layer of fat and blood vessels that are needed to keep the skin healthy. Since most of the nerves to the skin are also removed during SSM, the preserved skin and nipple usually remain numb permanently. 

The advantage of SSM is that it is usually combined with breast reconstruction to produce a reconstructed breast this is covered by natural breast skin. SSM also limits the extent of breast scars by allowing the entire procedure to be performed though the skin opening that is made to remove the nipple and areola. ​

Total Mastectomy (also known as simple mastectomy) removes the entire breast and its contents, leaving behind only enough skin to allow closure of the wound.

The nipple and areola are both removed. No muscle is removed. Total mastectomy (TM) is usually required when the surgeon feels that removal of the skin is beneficial for cancer control and wound healing. 

SSM is often necessary if the cancer is near the nipple or if the breast is too large or too low hanging to support the nipple and areola after removal of the underlying breast tissue. 

Removal of the nipple and areola reduces the concern that the nipple and/or areola may not survive the operation. The frequency of partial thickness or full thickness skin death (“necrosis”) after SSM is about 5 % though it depends upon a number of factors, the most important of which is surgeon experience, smoking, nicotine use, obesity, diabetes, large breast size, low hanging breasts, and the large size of breast reconstruction each increases the risk of areola and nipple necrosis. 

Partial thickness necrosis of the nipple and/or areola will usually heal relatively quickly (2-4 weeks) with proper wound care.
Full thickness nipple and/or areola necrosis may heal very slowly (1-2 months) or may require surgical removal. 

Complications of SSM include haematoma formation (accumulation of blood in the wound) (incidence <5%),


Infection (incidence <5%), and partial or complete skin necrosis (incidence <5%). 

Haematoma may require a return to surgery to remove the blood. Infection is treated with antibiotics and possibly catheter-drainage. Skin necrosis is usually treated with topical wound care for 1-2 months. SSM may be performed for the treatment of breast cancer or for prophylactic mastectomy for breast cancer prevention. It works best in A, B, and C-cup breasts.

When combined with breast reconstruction using an implant placed under the skin and chest wall muscle their may be other complications related to the implant. These include the formation of a capsule around the implant, more pain on the chest wall, and implant rippling, folding, rotation and rupture. Your surgeon will discuss each of these risks with you as they are more individual, depending on breast size, shape, and life style.

The left breast and nipple areolar complex have been removed and an immediate reconstruction performed using a silicone implant and Strattice Acellular dermal Matrix. Surgery by Mr Rick Linforth

Mastectomy-Removal of all of the Breast

TM can be combined with immediate breast reconstruction or reconstruction can be performed months or years later. 
The procedure leaves a scar across the front of the chest. Since most of the nerves to the skin are also removed during TM, the remaining skin has a reduced sensation or numbness. 

The advantage of Total Mastectomy is that it is the easiest mastectomy from which to recover.
It also has the lowest risk of complications compared to nipple and skin sparing mastectomy. It can be performed on a breast of any size. Most patients will then wear a prosthesis in the cup of their bra to look normal in their clothes. This is in the form of soft wool insert until the wound is healed, and then after about 6 weeks changed to a more permanent external silicone prosthesis.

Side effects from surgery are moderate pain, skin numbness, or bruising.

Seroma (a build-up of fluid under the wound) may also occur. 
Seroma formation can be managed with aspiration ( insertion of a needle to withdraw the fluid.)

Complications include haematoma formation (accumulation of blood in the wound) (incidence <5%), This may need evacuation under a short General Anaesthetic in theatre.

Infection (incidence <5%) requiring treatment with antibiotics and occasionally surgical drainage.

Partial or complete skin necrosis (incidence <5%) where some of the skin of the wound loses its blood supply dies. This may be managed with dressings if superficial, and occasionally requires a return to theatre for surgical debridement.

Most patients can return to normal activities within a few weeks ( 4-6 weeks).​