Why are all of the photos I've seen of mastectomy scars across the upper part of the breast? and why can't they be lower and curved like the contour of a natural breast?
What Determines the Mastectomy Scar Placement?
Doctor Answers 8
Not all mastectomy scars have to be the same
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!
Scar with mastectomy depends on several factors
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 designs for the scar for mastectomy has changed significantly in the last few years. the scar placement depend on the level of comfort of the general, or breast surgeon, whether a plastic surgeon is involved from the begining. and most important the position of the breast cancer.
Incisions these days can be designed to spare as much skin as possible, skin sparing mastectomy. The need for the nipple to be removed, if the general surgeon agrees, and how close the cancer is to the nipple and type of cancer, and the size of the breast
Incisions can be just around the nipple areola. In certain cancers and cases, the scar can be put in the breast creaseie inframammary incision with nipple sparing mastectomy.
The incision can be designed as a breast reduction incision if the opposite side needs a reduction so that both breast have the same type incision.
All these issues has to be discussed with the general surgeon , plastic surgeon and oncologist.
Then the plastic surgeon can design the incision and be part of the mastectomy and reconstruction team to assure optimal results and good cancer treatment plan.
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Too many unacceptable mastectomy scars!
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.
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+
Mastectomy scar and location
Mastectomy sacrs can vary a bit. Presuming it is being done for cancer and not prophylactic, the scar usually includes removng the areola and nipple and can extend toward the armpit to access the nodes.
Placement of Mastectomy scars
The location of mastectomy scars depends on multiple variables. Considerations include location and size of tumor, location of your nipple areola complex, your own anatomy, location of prior biopsy scars, patient history of immediate vs. delayed breast reconstruction, history of prior breast surgery, etc.
Please speak with your breast surgeon and ask to see a plastic surgeon for a consultation. Often, a plastic surgeon will work w your breast surgeon to facilitate some onco-plastic techniques to optimize placement of scars (if oncologically possible).
Hiding the Mastectomy Scar
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.