SKIN SPARING MASTECTOMY (SSM)
Skin sparing mastectomy (SSM) Austin
In this operation,only the mammary tissue is removed. This includes the entire breast and nipple-areolar complex but the skin and the axillary lymph nodes are spared. This operation is almost always followed by breast reconstruction. The nipple areolar complex can also be reconstructed but this is a separate procedure. The reason the nipple and areola are removed is because thereare milk ducts in the nipple and sometimes in the areola too, so in order to be as confident as possible that all the mammary tissue is removed the nipple and areola are resected “in continuity” with the breast.
Having said that, we know from experience that not every drop of breast tissue is removed with a mastectomy. In my opinion, the thoroughness of the operation varies widely depending on the skill and experience of the surgeon. I’ve seen cases where the breast was removed but the cancer was left behind. That’s why, in some cases, breast cancer recurs on the chest after mastectomy. This event is uncommon when the original cancer is small (approximately 3% chance). It is more likely when tumors are larger than 5 cm or if there is cancer in the axillary lymph nodes. In these cases, radiation to the chest wall after mastectomy is usually recommended to kill any cancer cells that may have been left behind.
The concept of sparing the breast skin evolved for two reasons:
- Surgeons observed that when the cancer was away from the skin, removing skin did not lower the chance that cancer would recur in the area where the breast was (local recurrence) and it did not improve survival.
- As reconstruction was introduced, it was obvious that the cosmetic outcome was about a billion times better if the surgeon saved the skin that naturally surrounded the breast tissue, the so-called skin envelope.
However, if cancer involves the breast skin, the skin should be removed along with the underlying breast. Examples of this are: