Editing Mastectomy (section)

== '''When to consider NSM/SSM''' ==

* Often provides the best cosmetic result for prophylactic mastectomy with immediate recon
* Local recurrence, when done for cancer, is comparable to standard mastectomy
* '''Nipple-sparing mastectomy''' (native skin and NAC are preserved)
** Predominantly used for women with small/moderate, non-ptotic breasts (risk of flap necrosis if the flaps are too big)
** Indications
*** Tumour does not involve nipple or skin - small, peripherally-located tumours
*** Tumour and glandular breast tissue can be removed with a negative margin
*** Incision and reconstruction choices can bring the nipple to an aesthetically desirable level
** Contraindications
*** IBC
*** Clinical or radiological involvement of the NAC
*** Nipple retraction
*** Paget disease
*** Bloody nipple discharge
** Ok with large and small breast, previous radiation, future radiation, and previous mastopexy or reduction.
** Results
*** Local recurrence rates are about the same as after skin-sparing mastectomy
*** Nipple recurrence is rare, and can be easily treated
* '''Skin-sparing mastectomy''' (NAC is removed but the overlying skin is preserved)
** Indications
*** Prophylactic mastectomy
*** Mastectomy for DCIS
*** Early stage breast cancer with immediate reconstruction
** Contraindications
*** IBC
** Technique
*** Make an appropriate incision (below)
*** Elevate skin flaps - same as for mastectomy, and then removing breast tissue from chest wall
*** Handle skin flaps carefully - more fragile than with mastectomy
*** Reconstruct - autologous vs non-autologous (see separate topic)