Skin Sparing vs.. Full mastectomy

I am 40, been on endocrine neoadjuvant therapy since January with some about 30% shrinkage 6 cm. now. ER+PR+/initially Grade-2 Lobular/


Because of large footprint fragmented area on my last MRI scan breast conserving operation is not an option  according to my surgeon. 


In August  my surgeon  proposed to do a mastectomy with temporising implant reconstruction of my right breast . It is likely that I’d need then radiotherapy .  


Six weeks later, however, he firmly suggested a full mastectomy as the most appropriate option for me. Motivating that skin sparing has complications, wound infections etc.


I am so scared even to visualize that I’d stay flat for many months before the reconstruction . 


Please let me know your experiences from both skin sparing and full mastectomies. 



Hi mrey300,


I thought I would reply because I have had both a skin-sparing, and full masetcomy.


firstly, sorry that you are facing a change in plans regarding your surgery. I can understand why it must seem a shock. I  first had breast cancer in left breast which required a WLE, so when I then found out I had a brac1 muation, I opted for bilateral mastecomies which I had using implant and strattice for immiediate reconstruction. This meant that my breasts looked exactly the same- better even.However, I went on to experience an infection in left breas due to poor healing as a result of radation. It was explained to me that the combination of radiation and implant raises risk of infection. This meant complete removal of skin and implant so a complete mastecomy.


I can completely understand your fear about losing a breast, but even with a reconstructed breast, it is still a loss, though less of a shock. I don’t want to miniimse impact of this, and we are all different so I have come across women who have thought that they want to be rid of cancer first, and then comes their concern about reconstruction. It wasn’t like this for me. But you know what, you find ways of coping and for you this will be a temporary situation while you get through treatment.


Let me know if you have any specific questions. Good luck and take care, Rattles x





I thought I would answer too. So sorry you are facing these difficult decisions.


I had a skin sparing bi lateral mastectomy last November. My lymph nodes were clear so my surgeon said I did not need  the planned radiation treatment as both breasts had been removed.


I had an immediate reconstruction with expander implants which are due to be replaced with silicon ones in November. They look pretty good and I’m told the permanent ones will feel and look better. I think it takes time for most women to get comfortable with their new implants.


May be it would help to talk to either your surgeon or breast nurse & Oncologist with regards to ALL your possibilities.

I would ask what are the chances of the cancer returning if you have the skin sparing  M.If you have the full M.Chic hormone drugs they are planning. How this affects the chances of the C returning.


I asked my Oncologist for % difference.  For me there was a 3% difference to the projected outcome of the C returning so opted for a skin sparing Bi lateral M.


I do not have experience of a full M so can only say that if a skin sparing M gives you the same or similar results in the chances of the C returning I personally would opt for that. However if the margins are very different then for me I would go for what gives you the best outcome.


Hope that is of some help.


Wishing you strength and good luck.





Hi m-rey,


To answer your question - I had two temporary implants, and now have one breast reconstructed with temporary implant. I’ve had this for a year and it is saline, it has a less natural feel, and it has a port. The original plan  was for it to be exchanged but as I had 5 operations in 14 months, I can’t face another and my surgeon says there is no rush.


In terms of ‘decision’ - I think some points have been made which are helpful, but my experience is that generally a conservative route with surgery wherever possible (hence your new plan was not the original plan). I had chemo before surgery the first time around and it shank my 4cmx5cm tumour to nothing so the mastecomy I was told would happen was then not needed (the reverse of your experience). I was lucky at the time, or so I thought as you have to remember if I had known I had a brca mutation I would have had the bilateral masectomies at that point instead of waiting 2 years and then getting another breast cancer. When I find myself wondering why I got breast cancer twice, I often look back and wonder if I would have coped as I really wanted to keep my breast.


I would ask questions - all the questions you need to ask - not just to understand the science, but as if you understand emotionally, it will help you cope emotionally. I am not explaining very well, but when I finally did lose a breast, though it was hard, I knew I had done everything I could and I understood why the reconstruction failed.


In terms of the future, I would have to have a reconstruction which took skin asthe skin across my chest is so poor, but I am usual and what you should be confident about is that there are good reconstruction options open available.


I am sorry you are having to get your head around this new challenge, I would suggest ringing the Helpline as they are so lovely and can help you work out what you want to ask and get your head round it.


Let me know if I can help at all.