Skin-Sparing Mastectomy (SSM)

What is the definition of a skin-sparing mastectomy (SSM)?

• Simple mastectomy (resection of the breast tissue for cancer diagnosis or risk reduction) that preserves the skin envelope.

What are indications for SSM?

• Not being a candidate for adjuvant radiation therapy as part of the Breast Conservation Therapy approach: previous breast or chest wall radiation therapy, certain connective tissue disorders, p53 mutation carriers

• Size of tumor precludes breast conserving surgery (large tumor to breast size ratio).

• Multicentric disease

• Persistently positive margins after multiple lumpectomies

• Cancer recurrence in breast where there was previous lumpectomy and radiation therapy

• Risk reduction

• Desire for immediate breast reconstruction

• Patient preference

What are advantages of SSM over traditional simple mastectomy?

• Preservation of native skin envelope

• Maintenance of natural contour and anatomic landmarks

• Improved cosmesis with immediate breast reconstruction

• Psychologic benefit to the patient

What are contraindications to the SSM approach?

• Inflammatory breast cancer

• Locally advanced breast cancers with extensive skin involvement; if skin only focally involved, can still consider SSM with focal resection of involved skin

What is the consensus on oncologic safety with use of SSM?

• The rates of local recurrence, distant metastases, and survival are clinically equivalent when compared to simple mastectomy.

What incision is routinely used when performing an SSM?

• Circumareolar (periareolar) incision resecting nipple–areolar complex

• Incision may be extended radially and laterally as transverse incision line in larger breasted patients to facilitate dissection (tennis racket incision)

• Circular periareolar incision used if autologous tissue flap is being used for immediate reconstruction; elliptical periareolar incision used in immediate expander-implant based reconstruction

• Reduction-pattern incision may also be used if trying to decrease amount of native ptosis

• Size and shape of incision make SSM more technically challenging than simple mastectomy

What are the borders of a mastectomy?