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Subcutaneous mastectomy is a type of skin-sparing mastectomy which removes tissue through an incision under the breast, leaving the skin, areola, and nipple intact. Some women who have prophylactic mastectomies prefer a subcutaneous procedure because it retains their nipples and offers very good cosmetic results. By working through the incision under the breast, the new breast is reconstructed without visible scars. Because a subcutaneous mastectomy leaves more tissue behind—working through the incision under the breast makes it impossible to remove as much tissue as a simple or modified radical mastectomy—this procedure is considered appropriate only as a prophylactic measure. Most physicians consider subcutaneous mastectomy inappropriate for women with large tumors, cancer of the breast skin, or with tumors under or near the nipple or areola. The subcutaneous procedure is different from a 'nipple-sparing mastectomy,” where the nipple is scraped free of breast tissue and replaced as a graft (see below).
In the 1998 study on prophylactic mastectomy in high-risk women, 90% of the mastectomies performed were “subcutaneous” mastectomies. However, of the seven women who did develop cancer after prophylactic mastectomy, all were in the subcutaneous mastectomy group. Although it is believed that there is more risk for breast cancer in the remaining tissue after subcutaneous mastectomy when compared with skin-sparing simple mastectomy, there is still a risk reduction with this surgery. The relative difference in risk reduction between subcutaneous mastectomy and simple mastectomy for mutation carriers is unknown. A review article discusses the relative risks and benefits of subcutaneous mastectomy as an option for risk-reducing mastectomy in high-risk women.