Skin-sparing Mastectomy

WHAT YOU SHOULD KNOW:

• Skin-sparing mastectomy (mas-TEK-to-me) is also called SSM or subcutaneous mastectomy. SSM is a type of mastectomy which is surgery to remove the breast. This may be done to treat breast cancer (tumor) while leaving much of the skin that covers the breast. This surgery may also be done as a form of prevention in women who are at a very high risk of getting breast cancer. With SSM, only the nipple and areola (dark circle around the nipple) are removed. This may also include the part of skin incised (cut) for biopsy or where a superficial (close to the skin) tumor is located. Sometimes, chemotherapy may be used weeks before SSM to shrink a large tumor.
  
  
• SSM is usually done in women who plan to have breast reconstruction during the same surgery. Breast reconstruction is surgery to make a breast that comes close in form and appearance to your natural breast. SSM may allow a more normal appearance of a reconstructed breast. This may help you to cope better with the loss of a breast. Women with breast cancer that involves the skin cannot have SSM. You and your caregiver will decide which breast cancer treatment is right for you.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• There are always risks with having surgery. You may bleed more than usual, get an infection, or have trouble breathing. You may have scars, shoulder stiffness, or swelling around the area where the breast was removed. If SSM is done with breast reconstruction, the breast skin may become folded and deformed. Sometimes, the skin may die if you have a problem with healing which may lead to more surgeries. The cancer may come back even after a successful treatment. Women who are obese, who smoke, have diabetes, or have had radiation are at a higher risk of problems.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If left untreated, breast cancer may continue to grow and spread to other parts of your body. This may lead to more serious and often life-threatening problems, such as heart, lung, liver, or brain damage. Once cancer spreads, it becomes more difficult to treat and other serious problems may develop. Your chances of stopping the cancer are better with early treatment. Call your caregiver if you are worried or have questions about your surgery, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your surgery:

• Caregivers will clean your chest area with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• Caregivers will make an incision (cut) around your areola. The incision may be larger to include a biopsy scar or the skin over a superficial tumor. The breast tissue is separated from the skin and removed. The axillary (underarm) lymph nodes may also be removed through the same incision, or through a second incision under the arm. Caregivers may need to cut more of your skin if you have large breasts. A reconstruction surgery may then be done to fill in the empty breast. Thin rubber tubes may be put into your skin to drain blood from your incision. The incisions are then be closed with stitches (thread) and covered with bandages.

After surgery:

You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. If you had general anesthetic, an adult will need to drive you home. Your driver or someone else should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.