Mastectomy for removal of breast tissue for pre-malignant or malignant breast conditions can be done through multiple incisions. Factors that contribute to the placement of incisions on the breast include the position of the breast tumor on the chest and it’s proximity to the skin. Classically, a mastectomy incision was located across the middle of the breast to accommodate for nipple areolar complex removal and access for axillary lymph node dissection. This long incision is difficult to conceal and problematic when performing a reconstruction of the breast because it flattens the contour of the breast. Skin sparing and areolar sparing mastectomy have evolved with the advent of sentinel lymph node dissection limiting the need for axillary lymph node dissection, this has changed the ability to create a very natural appearing breast after reconstruction. In women who undergo prophylactic mastectomy or in early stage breast cancer nipple sparing mastectomy has become more popular. Initial studies did demonstrate oncologic safety in this procedure with the removal of breast ductal tissue while maintaining the areola and nipple skin. Nipple sparing mastectomy can be combined with an immediate breast reconstruction with either an implant or an autologous breast reconstruction. A nipple sparing mastectomy and breast reconstruction should be performed on breasts without a significant amount of sag or ptosis. It is impossible to lift the position of the nipple areolar complex after a mastectomy is performed because the blood supply to this area has been compromised. I only provide this option in a breast that has a low-grade oncologic stage that will not need radiation, and has a normal nipple height. That makes this option for breast treatment not always the right option, but it can be combined with an immediate placement of a breast implant, tissue expander or an autologous free flap such as a DIEP flap or free TRAM. The incision for this mastectomy is in the fold or a vertical incision. The beauty of the vertical incision is that is heals very well and it can provide a minor breast lift.
A consultation with Dr. Trussler will help define an individual plan for you. The ability to perform all of these breast reconstructive procedures gives you a choice that is individual and right for you. Dr. Trussler will make your reconstructive breast surgery a pleasant experience and will guide you at each step of this process. He will give you the option of surgical location and it will likely necessitate a one night overnight stay so that you are comfortable and confident during recovery after this type of surgery. Physical activity can be resumed after 2 weeks and scar care is started after 3 weeks with the goal of buying new bras in 6 weeks.
