Skin-Sparing Mastectomy

Surgery of breast cancer has evolved dramatically in the past few decades. The art of surgery was extricated from the previous status of the barber’s trade to a more esthetic form on the basis of a strong anatomical delineation of the human body. Beginning from the era of radical mastectomy to modified radical mastectomy and now to even more conservative approaches. This shift was seen with various changing theories of its pathophysiology and spread. While disease control remains the primary aim of breast cancer treatment, improved esthetic outcomes have a continuous positive impact on patient’s life. Many new surgical procedures like skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have emerged from the concept of oncoplastic breast surgery. The SSM involves complete extirpation of breast ducto-lobular tissue with preservation of skin to allow for reconstruction, achieving a satisfactory appearance and shape of the breast with an improved esthetic and quality of life. Several nonrandomized trials have exemplified comparable oncologic outcomes of skin-sparing mastectomy with immediate breast reconstruction and conventional mastectomy alone. The SSM is done for extensive ductal carcinoma in situ (DCIS), and for patients undergoing risk-reducing bilateral mastectomy. Rate of complications are similar to those of postmastectomy reconstruction. Thus, SSM is safe and gives good esthetic outcomes with proper reconstruction.