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.


image    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


image    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


image    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


image    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.


image    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


image    What are the borders of a mastectomy?


  Superior: clavicle


  Medial: lateral border of sternum


  Lateral: anterior border of latissimus dorsi muscle or mid-axillary line


  Inferior: inframammary fold or upper rectus abdominus muscle


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Aug 28, 2016 | Posted by in Reconstructive surgery | Comments Off on Skin-Sparing Mastectomy (SSM)
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