Skin Sparing Mastectomy (SSM)

Skin sparing mastectomy is a technique that can be used during a mastectomy. A mastectomy is a surgery to remove a breast.

The technique allows the breast to be reconstructed during the surgery. Most women are candidates for this technique.

Tell a health care provider about:

• Any allergies you have.
• Whether you are pregnant or may be pregnant.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Death of tissue (necrosis). People who use tobacco are at increased risk for this problem.
• The formation of a pocket of clear fluid (seroma).
• A skin infection caused by bacteria (cellulitis).
• Nerve damage due to poor positioning of the arm during surgery.
• A blood clot (hematoma). This is rare.
• A collapsed lung (pneumothorax). This is rare.

What happens before the procedure?

• You may be checked for extra fluid around your lymph nodes (lymphedema) in the area around the affected breast.

Hydration

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicine

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• An incision will be made, and breast tissue and the nipple will be removed.
• Tissue from the area may be sent to be examined under a microscope to look for cancer cells (biopsy).
• Lymph nodes in the area may be checked for cancer and removed if necessary.
• Skin around the breast will be preserved to form a pocket with flaps that will be developed to insert a breast implant.
• An implant may be inserted into the pocket made by the flaps.
• A tube will be placed to drain blood and fluids that collect in the surgical area.
• The incision will be closed with sutures (stitches), skin glue, or skin adhesive strips.
• A gauze bandage (dressing) will be put over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• You will likely have to stay at the hospital overnight so that your health care providers can make sure:
  • You are able to tolerate pain-relieving medicines and other medicines.
  • You are able to eat.
  • You are hydrated.
• You will be told how to care for your drain and incisions at home.
• Do not drive until your health care provider approves.

Summary

• Skin sparing mastectomy (SSM) is a technique that allows the breast to be reconstructed during a surgery that is done to remove a breast (mastectomy).
• For the procedure, you will be given a medicine to make you fall asleep (general anesthetic).
• You may need to stay in the hospital overnight after the procedure.

Skin Sparing Mastectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Breast swelling.
• Breast tenderness.
• Stiffness in your arm or shoulder.
• A change in breast shape.
• A change in how the breast feels.
• Pain.
• Numbness or tingling.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Take your antibiotic medicine as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

Bathing

• Take sponge baths until your health care provider says that you can start showering or bathing.
• Do not take baths, swim, or use a hot tub until your health care provider approves.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid exercise that requires a lot of effort (is strenuous).
• Be careful to avoid any activities that could cause an injury to the arm that is on the side of your surgery.
• Do not lift anything that is heavier than 10 lb (4.5 kg). Avoid lifting with the arm that is on the side of your surgery.
• Ask friends and family to help with child care, meal preparation, laundry, and shopping.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive until your health care provider approves.

Incision care

• Avoid wearing a bra following your procedure to allow the incision to heal. Your health care provider will tell you when it is safe to wear a bra.
• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Keep your dressing dry.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

General instructions

• If you have a drain, empty the fluid from the removable drain bulb as directed by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You cannot eat or drink without vomiting.
• You have redness, swelling, or pain around your incision or drain.
• You have fluid or blood coming from your incision or drain.
• Your incision or drain area feels warm to the touch.
• You have pus or a bad smell coming from your incision or drain.

Get help right away if:

• You have a fever.
• You have new or sudden chest pain.
• You have chest pain or trouble breathing that gets worse.

Summary

• Take your antibiotic medicine as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Check your incision area and drain area every day for signs of infection, such as redness, swelling, pain, fluid, blood, warmth, pus, or a bad smell.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Keep all follow-up visits as told by your health care provider. This is important.