A subcutaneous mastectomy is a surgery where a surgeon removes breast tissue through an incision just below the breast to spare as much skin as possible and leave the nipple intact. This approach may be recommended to treat some forms of breast cancer and can also be used in prophylactic mastectomy surgeries to prevent the occurrence of breast cancer in patients with a risk of this condition. There are some risks to this procedure, of which the most important may be that the risk of breast cancer or recurrence is higher with this as opposed to other mastectomy options.
The advantage of the subcutaneous and other skin-sparing mastectomy procedures is that they make it easier to perform reconstructive surgery. More tissue is left in place for a reconstructive plastic surgeon to work with, and this can result in a better cosmetic outcome. The scar may also be less visible because of the position under the breast. Some patients may prefer this to avoid questions or comments in the future.
Conversely, the subcutaneous mastectomy can have disadvantages for patients with extremely large or locally aggressive cancers. In these cases, the cancer may spread too far for the surgeon to get all of it with a subcutaneous mastectomy. If the surgeon performs the procedure anyway, the cancer can recur in the remaining breast tissue. In prophylactic surgeries, the leftover tissue could be large enough for a tumor to develop at some point in the future.
Surgeons carefully evaluate the risks and benefits before proposing treatments to their patients. They have concerns about cosmetic outcomes because they can have an impact on patient quality of life, but their first priority is to save the life of the patient. If they feel that a subcutaneous mastectomy would not be in a patient's best interests, they may not bring it up as a treatment option or might recommend against it if a patient asks. Patients can ask for second opinions or advice from other surgeons.
In a subcutaneous mastectomy with immediate reconstruction, a plastic surgeon will work immediately after the oncology surgeon in the operating room to restore the breast's appearance. This can reduce the risks associated with a second surgery to rebuild the breast. It may not be an option in all cases, as a surgeon may want to wait to determine how the patient responds to treatment before proceeding with reconstruction.