What Determines the Mastectomy Scar Placement?

The answer to your question is yes the scar can be moved to different locations depending on who is doing your mastectomy.  When a board-certified plastic surgeon is involved, he/she can help place the scar in a location/configuation that is more suitable and aesthetically pleasing.  Ask you surgeon for other options than the traditional long scar across your chest. Best of Luck!

A mastectomy requires removing the nipple and the surrounding skin.  This frequently results in a high transverse scar on the breast mound.  However, if you have excess breast skin that is above the nipple and not involved with the cancer, this can be pulled down.  The final result can be a scar in the hidden inframammary fold.  Scar placement is determined by the location of the cancer, the amount of skin that you have in your breasts can be preserved and the skin of the general surgeon and plastic surgeon.

Best of Luck,

Gary Horndeski, M.D.

The traditional mastectomy is designed to remove all of the breast tissue, and since the nipple is where the milk ducts come up to the surface it is considered part of the breast. The scar would then be unavoidably located at the level of the nipple. The good news is that there is a trend toward skin-sparing mastectomy and nipple-sparing, so then the incision placement can be determined by other factors. If you are considering mastectomy, definitely talk to a plastic surgeon beforehand about immediate reconstruction. This is the other big trend, increasingly all in one stage with an Alloderm internal bra and implant.

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.