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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• You may need to have blood and urine tests, a mammogram, chest x-ray, and other tests. Ask your caregiver for more information about these tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Remove any nail polish.
  
  
• You may be given a pill to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery. Tell your caregiver if you or any member of your family has had a problem using anesthesia in the past.
  
  
• You will be asked to sign a legal piece of paper (informed consent). It gives a caregiver permission to do the procedure. If you are unable to give your consent, someone who has permission can sign this form for you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Treatment

What will happen:

• You will be asked to change into a hospital gown. You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room. You may be given a general anesthesia to keep you completely asleep during surgery. Caregivers will clean your chest and the areas around the breast with soap and water. Sheets will be 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 will then be 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. They may then proceed to reconstruction surgery to fill in the empty breast. Thin rubber tubes may be put into your skin to drain blood from your incision. The incisions will 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. An adult will need to drive you home and should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have a skin infection or an infected wound near the area where surgery will be done.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You feel a new lump in your chest or other breast, or axilla (underarm), or see or feel other changes.
  
  
• You have discharge coming from your breast.
  
  
• You have redness, swelling, or severe pain in the breast.

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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.