The prospect of losing a breast is unimaginable to anyone who has never been in that position. Every woman will have her own very personal and individual response and reaction. It may be of some comfort however for patients to know that an Oncoplastic Breast Surgeon will be able to plan the most 'thoughtful mastectomy' possible and help make life after mastectomy as manageable as possible.
Whether or not a breast reconstruction is planned immediately (Immediate Breast Reconstruction) or at sometime in the future (Delayed Breast Reconstruction), the aim of the mastectomy is to remove all the breast tissue (usually but not always with the nipple) and to leave the chest as acceptable as possible in the circumstances.
Careful and meticulous planning is crucial even for a simple mastectomy without reconstruction. The aim should always be to avoid an unsightly scar and to leave the skin as smooth and even as possible, particularly towards the underarm area. This will then allow a smooth and accurate fit for an external prosthesis within a special mastectomy bra. Planning a mastectomy scar well is particularly important if there is a possibility of a delayed reconstruction in the future (see reconstruction information).
If an Immediate Breast Reconstruction is planned, then the breast tissue (with or without the nipple) is removed as a skin sparing mastectomy. In most cases the breast skin is usually perfectly healthy. The aim of the mastectomy is to remove the breast tissue meticulously and delicately from inside the breast skin envelope and only remove the skin that may be unhealthy. The breast envelope is then prepared to be the perfect shape to 'house' the breast reconstruction inside; in some cases the skin envelope may be reduced or crafted into a more ideal size or shape ( reduction type skin sparing mastectomy).
Depending on the extent and type of disease, a patient may be able to choose to keep her nipples; this is known as nipple preserving skin sparing mastectomy. Sometimes however it may be safer for the nipples to be removed at the time of the mastectomy. This is known as nipple sacrificing skin sparing mastectomy. The nipples can then be reconstructed at some time in the future, once the breast reconstruction has fully healed (see nipple-areola reconstruction leaflet.)
Skin sparing mastectomy has been proven to be as safe as simple mastectomy and is no more likely to lead to a future problem (with cancer recurrence or delaying future cancer treatments because of complications) than if a simple mastectomy is performed.