What Determines the Mastectomy Scar Placement?

The mastectomy scars can be placed in well hidden shadows of the breast curve. These techniques may be combined with plastic surgery techniques in reconstruction. The term used for this type of surgery is oncoplastic. The most qualified surgeon to do this type of surgery is a board certified plastic surgeon who is also a board certified general surgeon. Good Luck!

As a general surgeon who performs mastectomy surgeries, the planning of the incision depends on where (or if) cancerous tissue is present and what the plan is for reconstruction. Far too many patients are subjected to scars that are too large, too central and obvious, and that don't take advantage of the natural hiding spots the breast provides. In my practice, there are very, very few times when I cannot use an inframammary fold incision that is hidden by the breast that overlaps the incision and hides it. This is done with nipple sparing technique as well, so that the final appearance looks nothing like a stereotypical mastectomy scar. Some of the exceptions to my practice would be ladies with very large or droopy breasts and my plastic surgery associates want to lift the breast and the only way to do that is to remove some of the skin beneath and around the nipple/areola. If there is a pre-existing scar, it makes sense to use what is already there. Sometimes the cancer is involving the skin or nipple and in order to obtain cure, that tissue must be taken. Having the cancer "close" to skin or nipple does NOT mean it must go. Older recommendations said that cancer had to be greater than 3 cm away from the nipple in order for the nipples to be saved, but this is no longer the case. If you are working with a surgeon who refuses to perform or try nipple sparing mastectomy, consider getting a second opinion as to why this is the case. I have had many successful nipple sparing mastectomy patients who were told by other doctors that nipple sparing would not be possible. The main reason surgeons make (what I think are) unacceptable incisions routinely is because it is the easiest approach for the surgeon. More room to work makes it  much easier to see the tissue and the operation typically goes much faster. If the operation is at a teaching institution, the junior surgeons or medical students have a better view and an easier operation to learn. BUT - this is what the patent has to live with for the rest of her life. Hiding the scar and making is as small as possible certainly makes my job in the OR more challenging. But I have never regretted it and my patients LOVE their results.