Subcutaneous mastectomy, indications and techniques

In this paper the indications, the technique and our personal experience with 45 subcutaneous mastectomies (S.C.M.) are reviewed. A bilateral S.C.M. is mainly a prophylactic operation, indicated in patients with premalignant breast disease and in high risk patients with widespread fibrocystic disease. A unilateral S.C.M. is indicated in patients who have already had a mastectomy for carcinoma and whose remaining breast has an increased risk for also developing a carcinoma. The technique which we nowadays prefer, consists of a S.C.M. with immediate submuscular prosthetic reconstruction. The operation is done through a transverse incision for small non ptotic breasts and following a Mc Kissock reduction mammoplasty pattern for large ptotic breasts. The nipple-areola complex is transposed on a wide dermal pedicle. Both the subcutaneous and submuscular spaces are drained and early postoperative mobilisation of the prosthesis is advised. Our experience with 45 subcutaneous mastectomies is reviewed. The complications have been few and occurred mainly in earlier cases where the prosthesis was inserted subcutaneously. Neither necrosis nor circulatory embarrassment of nipple-areola complex were encountered.