I Am Booked in to Have a Bilateral Prophylactic Mastectomy and Would Like to Know Where the Scarring Would Be Please?

While this depends on the technique used by your surgical oncologist, the most common scar after mastectomy is horizontally across the width of the entire breast at the level of the nipple. In order to remove the nipple areolar complex and the breast gland as a single specimen, most general surgeons opt to use an ellipse with a transverse orientation. This approach is commonly followed by a two-stage breast reconstruction with the tissue expander/implant technique.

Several modifications of this technique do exist, and depend--in part--on the nature of breast reconstruction.  In certain cases, a circumareolar approach may be used. This is essentially a "lollipop" scar that is around the nipple with a horizontal component extending laterally. This may be employed in cases of natural tissue breast reconstruction (e.g. TRAM or DIEP flap) as the reconstructed tissue may be sewn into the old nipple location.

The most exciting new techniques are the so-called nipple-sparing mastectomy approaches. In these operations, the nipple remains in place, and the scar is made around the bottom of the nipple and horizontally toward the outside of the chest. Because the nipple is not removed, the general surgeon needs to take an additional specimen from the underside of the nipple to make sure there is no residual breast tissue or cancer in that location. This technique provides the potential for a more natural appearing nipple areolar complex, and multiple reconstructive techniques can be employed. A single stage, immediate breast reconstruction with implants has also gained recent attention. If there is enough skin remaining after mastectomy surgery (i.e. in women with previously large breasts) a breast implant can be placed at the time of the original surgery, and no further tissue expansion or implant exchange is required.

Regardless of the mastectomy and reconstructive techniques used, a double prophylactic mastectomy has become a common choice of action for women at high risk who wish to avoid the possibility of developing breast cancer. With the help of your board certified plastic surgeon, this can be a rewarding decision that can provide you with peace of mind, cancer-free.

There are traditional incisions around the areola in skin sparing mastectomy. There are several others depending on other factors. Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.



If
you are interested in being seen in Austin please give us a call. I know
this is a difficult time for you. The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

Thank you for your question.   Much of the literature published in the breast surgery literature centers around preservation of the nipple/areola when possible and skin incision design to maximize cosmesis.

My preferred method is a lollipop or question mark incision which traces the areola border and then extends vertically to the crease/inframammary fold.   The advantage of this technique is that it allows us to apply our principles of breast lift to breast reconstruction.

I have performed breast lifts on several DIEP Flap breast reconstruction patients with this method to help achieve optimal shape and symmetry.   

The beauty of nipple/areola preservation with this technique is that I can achieve results that mimic a breast lift or breast reduction longterm.

I wish you a safe recovery and fantastic result.

Dr. GIll