Robert J. Allen M.D.

Tissue Preserving Mastectomies

When radical mastectomies became a thing of the past, so did its medical mindset.  Because research has shown that the radical mastectomy is no more effective than less extreme forms of mastectomy, but only significantly more disfiguring and difficult to reconstruct, the medical community has since focused on tissue preservation and the concept that “less isn’t always more.”  For mastectomies, such tissue preservation takes on many forms and available options vary directly with a patient’s specific condition.

A modified radical mastectomy (MRM ) is a less extreme and widely used form of mastectomy.  Unlike its predecessor, the MRM only removes the breast tissue and axillary lymph nodes, leaving the pectoralis muscle in place and intact.  Similar to the modified, a total mastectomy does the same, only without axillary lymph node dissection.  For both, the breast skin may or may not be removed.

A skin sparing mastectomy (SSM) is a total or modified radical mastectomy with the preservation of the breast skin.  This form of mastectomy allows for a very pleasing reconstructive result, as it provides a breast envelope for shape and volume to be restored.  Both immediate and delayed reconstruction can take place with SSM.  However, a later procedure will be required to recreate the nipple and areola.

A nipple sparing mastectomy (NSM) is a skin sparing mastectomy with the preservation of the nipple/areola complex.  As far as complete mastectomies go, this is the least extreme, most tissue preserving technique and is ideal for immediate reconstruction.  Both the mastectomy and reconstruction take place through a single lateral or vertical incision, and the nipple remains in place and intact.  However, studies have shown that although the nipple/areola complex is preserved, it may never regain any sensation.

As a note, leaving any tissue behind always poses a risk.  For this reason, not all breast cancer patients are candidates for every type of tissue preserving mastectomy.  If you are considering a mastectomy and reconstruction, meet with your breast surgeon to determine the criteria your condition meets and what tissue preserving mastectomy may be suitable for you.

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