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.