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What you should know about mastectomy scars

A mastectomy is one way to treat breast cancer by surgically removing the breast or part of the breast. Scarring is a result of the surgery.

The incision and surgical approach a surgeon uses during a mastectomy depends on both the amount of breast tissue that needs to be removed and the woman's desire for reconstruction after the procedure.

Fast facts on mastectomy scars:

  • Surgical approaches such as nipple surgery can change the appearance of scars.
  • The approach may depend on the size and extent of the tumor.
  • A woman's desire for reconstruction also determines the type of incision.

Mastectomy incision approaches

Often times, the appearance of a mastectomy scar depends on the incision and approach a surgeon takes.

To begin the surgery, a surgeon will make an incision in the skin of the chest to expose the inner part of the chest.

Once the surgeon has removed the breast tissue, muscles, and lymph nodes as needed, the surgeon will suture the skin where the incision was made.

When the wound heals, a mastectomy scar will form. Despite the different approaches outlined in this article, most mastectomy scars heal in a horizontal line across the chest, sometimes in a crescent shape. Often times, the type of cut and the resulting scar will depend on where the breast cancer appeared in the first place.

Over many years of breast surgery, the approach surgeons take to making a surgical incision has changed significantly. There are now a wide variety of surgical options for women and they should be sure to ask their surgeon what approach they would like to use and what the result might be.

What types of mastectomy cause scarring?

While all forms of mastectomy result in some scarring, there are a number of approaches a surgeon can take:

Partial mastectomy or lumpectomy

A partial mastectomy involves removing the tumor and some breast tissue. Sometimes the surgeon also removes part of the lining covering the pectoral muscles.

A lumpectomy usually leaves a small linear scar on the skin of the chest. Sometimes surgeons can make the incision in the crease under the breast or around the nipple to hide the scar.

A partial mastectomy will leave most of the breast intact, so reconstruction is usually not necessary. Women who have a lumpectomy will need radiation treatment after surgery.

Skin-friendly mastectomy

This surgical approach is typically performed on women who are planning a reconstruction immediately afterwards. It involves removing the breast, areola, and nipple and lymph nodes or lumps, but preserving the rest of the woman's breast skin.

Preserving the majority of the breast skin allows for immediate breast reconstruction with an implant or the woman's own tissue. A mastectomy that is gentle on the skin usually leaves a visible medium to large scar on the front of the breast. However, the surgeon might be able to hide the scar by making the incision in a less obvious location.

Nipple-friendly mastectomy

A woman undergoing prophylactic or preventive mastectomy, or who has small or early breast cancer, could be a candidate for a nipple-tolerable mastectomy. This procedure involves preserving the breast skin as well as the areola.

This technique is typically done on women with smaller breasts and results in a scar on the side of the breast. However, the surgeon can make the incision in the crease below the chest at the bust line so that the scar is not visible.

Simple mastectomy or total mastectomy

This surgical approach involves removing the breast, areola, and nipple, and sometimes lymph nodes, as well as a variable amount of breast skin, depending on the plans for the reconstruction.

The chest wall and lymph nodes that are further from the chest, such as the axillary lymph nodes in the armpit, are not removed.

The surgeon typically makes an oval incision that runs the width of the breast around the nipple, leaving a visible scar.

Modified radical mastectomy

Similar to a simple mastectomy, this approach removes all breast and breast tissue, as well as lymph nodes in the breast and armpit. The chest wall is often left intact. A modified radical mastectomy results in a large, visible scar on the chest.

Additional treatments

The goal of mastectomy, or oncological surgery, is to remove only as much tissue as is necessary to treat the woman's cancer.

A breast surgeon and oncologist will discuss the options and help a woman make the best decision for her. After surgery, a woman will likely have drainage tubes and will take several weeks to recover.

Some procedures, such as lumpectomy, usually do not require hospitalization, while mastectomies often require hospitalization.

The length often depends on the type of mastectomy a woman had, as well as the type of reconstruction.

After the mastectomy, a doctor may recommend radiation therapy or chemotherapy to shrink or kill any remaining cancer cells. This can affect the healing of the wound.

A woman should look out for signs of infection such as warmth, redness, or drainage from the surgical site, as well as a fever, which could indicate a systemic infection.

Breast reconstruction after mastectomy

Breast reconstruction is another post-mastectomy surgical option, in which a surgeon recreates the appearance of a woman's breast or breasts either at the time of the mastectomy or at a later date.

A surgeon can take tissue from another part of a woman's body, use breast implants, or a combination of both to reconstruct the breast.

Tissue expansion and implants

When a woman chooses to have an implant reconstruction, a doctor places a device known as a tissue expander under the pectoral muscle or breast skin.

This can be done at the same time as the mastectomy (immediate reconstruction) or in the future (delayed reconstruction). The woman has to visit the doctor several times to fill the implant with saline to expand it.

Once the breast skin has stretched and healed after the operation, a surgeon can place a permanent implant. This usually happens around 2 to 6 months after the mastectomy.

However, some women have a permanent implant placed at the time of the mastectomy.

Autologous tissue reconstruction

Another option is autologous tissue reconstruction, also known as "flap" reconstruction. In this procedure, a doctor takes tissue from the woman's abdomen, back, or buttocks and uses the pleura flap obtained during the mastectomy to reconstruct the breast.

These can be very detailed procedures as a surgeon sometimes needs to reconstruct the circulation to the breast tissue.

Again, this type of reconstruction can be performed at the time of the mastectomy or at some point in the future.

What if a woman doesn't choose to rebuild?

According to BreastCancer.org, an estimated 44 percent of women who have a mastectomy choose not to have a follow-up exam.

Many women choose not to have their breast reconstructed for various and personal reasons. Some of these can include:

  • Health concerns that could make future surgeries dangerous or ill-advised.
  • The desire to resume daily activities faster.
  • Worried about removing tissue from other areas of the body or using an implant to reconstruct the breast.
  • Concerns about the cost of rebuilding.

Some women who do not choose to have a reconstruction may choose to wear a prosthetic or artificial breast that can be tucked into a bra, or an adhesive breast-shaped device that is attached to the woman's body.

Some women do not want to use these options and may refer to their decision not to use a prosthesis as a "broke".

Reduction of scarring without reconstruction

If a woman chooses not to undergo reconstruction, she should speak to her doctor about surgical options that can make the mastectomy scar and resulting skin as comfortable as possible.

For example, a surgeon can make sure the scar is as flat against the chest as possible, which can make the chest feel smooth. Otherwise, some women will be left with skin rolls on their chests, which can create a plump look.

While that's not harmful, many women don't like the way it looks.

Sometimes a surgeon can make what is called a "Y" incision cut, which adds two small incisions at the end of the traditional long cut. This can reduce the incidence of plump skin.

Mastectomy tattoos

In February 2017, an article titled "The Healing Role of Post-mastectomy Tattoos" was published, detailing the work of a tattoo artist who worked with women to create tattoos over mastectomy scars.

This is an emerging approach for women who choose not to have breast reconstruction.

Some women also have breast reconstruction and choose to have a tattoo artist tattoo a nipple that looks three-dimensional. There are tattoo artists who specialize in this approach.

Outlook on mastectomy scars

The decision to reconstruct a breast, cover a mastectomy scar, or live without a prosthesis is truly a woman's decision. It is important that she speak to a surgeon about all of her options.

If she feels that a doctor is disregarding her needs regarding reconstruction or the decision not to reconstruct the breast, she may want to get a second opinion.

Sometimes a woman may want to delay making the decision about reconstruction until her mastectomy.