Defining skin-sparing mastectomy surgical techniques: a narrative review

Background and Objective: The last few decades have witnessed remarkable advancements in the field of surgical breast cancer management. Compared to earlier historical periods when non-invasive interventions were prioritized, comprising up to 70% of breast cancer management, surgical intervention has now become an increasingly viable alternative. These advancements have been made possible by expanding the indications for surgical intervention, such as risk-reducing mastectomy for individuals with BRCA1 and BRCA2 mutations, as well as updating magnetic resonance imaging staging protocols. As a result, mastectomy rates have increased significantly. Coinciding with this trend is the emergence of breast reconstruction as a safe and indispensable surgical procedure that can help mitigate potential complications. Initially, immediate breast reconstruction post-cancer treatment aimed to address treatment-related defects; however, the focus has shifted towards achieving aesthetically satisfactory breast appearance, shape, and consistency. Since the 1990s, the skin-sparing mastectomy (SSM) technique has been introduced to conserve breast tissue and eventually evolved to preserve the nipple-areola complex (NAC). Methods: This review has synthesized the latest evidence on the SSM technique, indications, outcomes, and optimal reconstruction timing. Key Content and Findings: To ensure good aesthetic outcomes while maintaining local cancer control, certain criteria must be met, including an experienced surgical team, a multidisciplinary evaluation, appropriate patient selection, and adequate margins. During SSM, the surgeon employs a meticulous approach by carefully selecting the incision type and preserving the cutaneous pocket and sub-mammary fold, which can enhance aesthetic outcomes. Additionally, this approach may reduce the number of procedures for breast reconstruction and improve symmetry conservation in both the reconstructed and contralateral breasts. Conclusions: SSM is a surgical technique offering promising aesthetic outcomes and effective local cancer management. However, the safety and efficacy of the procedure depend on stringent criteria, including an adept surgical team, a comprehensive multidisciplinary evaluation, careful patient selection, and the attainment of satisfactory margins. The meticulous choice of incision site and type, preservation of the cutaneous pocket and sub-mammary fold, contribute to enhanced cosmetic results. Moreover, SSM permits immediate reconstruction post-surgery, potentially reducing the necessity for subsequent reconstructive procedures.