Mastectomy is a surgical procedure used to treat or prevent breast cancer. It involves the removal of some or all of the tissue inside a breast, and may also include removal of associated lymph glands. In some forms of mastectomy, the skin covering the breast is also removed. Skin-sparing mastectomy is a form of the procedure designed to allow tissue removal while retaining the majority of breast skin.
Determining Suitability for a Skin-Sparing Procedure
According to the nonprofit organization BreastCancer.org, a skin-sparing mastectomy can be performed as part of any traditional mastectomy surgery, including simple, total, or radical procedures. However, you will typically not be considered for a skin-sparing mastectomy if you suffer from inflammatory breast cancer, or show other signs of cancerous cells near the inner margins of your breast skin. The procedure is also usually not an option if you do not wish to undergo breast reconstruction as part of your mastectomy.
Phase One: Mastectomy
At the beginning of your skin-sparing mastectomy, your surgeon will remove the nipple and areola from your affected breast. He will also remove the skin from any existing biopsy scars. He will then perform your mastectomy and remove your breast tissue through the opening provided during the first phase of surgery. The exact amount of tissue and associated structures removed will vary with the type of mastectomy you receive. At the end of your procedure, your breast skin will remain as an empty pouch to be filled during breast reconstruction.
Phase Two: Reconstruction
Several forms of reconstruction are commonly performed in association with a skin-sparing mastectomy. Prior to your surgery, you and your doctors can determine which procedure is most appropriate for you.
In a TRAM flap reconstruction, your surgeon will rebuild your breast with your transverse rectus abdominis muscle, which is located in your lower abdominal wall below your navel. Skin and fat associated with this muscle will also be used. A primary TRAM procedure is typically completed at the time of your mastectomy. If you want to restore the appearance of your nipple, a second minor surgery will be performed at a later date.
In a deep inferior epigastric artery perforator (DIEP) flap procedure, your surgeon will remove fat and skin from the same area used in a TRAM reconstruction, but will leave the muscle intact.
In a latissimus dorsi flap reconstruction, this muscle and associated skin from your upper back are detached and shifted under your skin to your breast pouch. Once this tissue is in place, your surgeon will place a saline implant inside of it to give your breast a full appearance. Typically, other muscles in the back compensate well for the missing latissimus dorsi, and few functional problems occur.
In a gluteal free flap reconstruction, your surgeon will use muscle and associated tissue from your buttocks. This procedure may be employed if abdominal tissue removal is medically or psychologically inappropriate.
Consult your oncologist (cancer specialist) and surgeon for more details on skin-sparing mastectomy and its associated procedures.
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