Breast Care A-Z · Procedure · SSM

Skin-sparing mastectomy

also: SSM

A skin-sparing mastectomy removes the breast tissue and nipple while preserving most of the breast skin, creating a pocket for immediate reconstruction. You may have been told it is recommended, or be weighing the differences between mastectomy types — it is the modern default for mastectomy with immediate reconstruction where nipple-sparing isn't suitable.

Quick answers

Why am I being offered SSM rather than NSM?

Usually because something about your case makes nipple preservation less suitable — the cancer's position close to the nipple, breast size or shape that complicates nipple preservation, or a clinical concern with nipple involvement. The specific reason in your case is explained at consultation.

Will I have a scar around my breast?

Yes — the incision is around the areola, often extended laterally for access. Once the reconstruction is in place, the scar is the natural circle that would appear if the areola were tattooed back later. The scar fades over 12 months.

Can I have nipple reconstruction later?

Yes. Nipple reconstruction is a small day-case procedure typically done 6–12 months after the original mastectomy, followed by areolar tattooing a few months later. The combination produces a convincing result for most patients.

Skin-Sparing Mastectomy -- Breastory Encyclopaedia Plate LXX Plate covering skin-sparing mastectomy (SSM): incision design, skin flap elevation, oncological safety, reconstruction options and comparison with standard and nipple-sparing mastectomy. SURGERY · OPERATIVE PROCEDURES PLATE LXX skin-sparing mastectomy SSM · envelope-sparing mastectomy mastectomy preserving the breast skin envelope and inframammary fold while removing the nipple-areola complex, optimising reconstruction outcomes FIG 01 — Skin-sparing mastectomy: pre-op, flap elevation, completed SSM Pre-op Flap elevation Completed SSM tumour periareolar incision skin envelope pec muscle (dissection plane) NAC removed skin flap elevated (thin <5mm) IMF preserved tissue expander (within pocket) NAC defect skin envelope intact (preserved) i — periareolar incision: NAC + small ellipse removed ii — preserved skin envelope (retained in SSM) iii — inframammary fold (IMF) preserved iv — pectoral fascia dissection plane v — immediate reconstruction within preserved skin pocket SSM vs NSM SSM: removes NAC NSM: preserves NAC Both: preserve skin envelope + IMF SSM when: nipple involved or <2cm away SSM when: prior NAC biopsy positive Oncological considerations Skin flap thickness Aim <5mm (subcutaneous plane) Residual tissue risk Routine biopsy not standard Skin recurrence rate ~1–2% (equivalent to std Mx) FIG 02 — SSM vs Standard mastectomy vs NSM: 10-point comparison Parameter SSM Standard / NSM Skin preserved Envelope + IMF (no NAC) Ellipse removed / Envelope + NAC + IMF NAC Removed Removed / Preserved Incision Periareolar Oblique-horizontal / Periareolar or IMF Reconstruction Optimised — preserved pocket Skin expansion needed / Best cosmetic Scar Periareolar ring Chest scar / Periareolar or IMF Oncological safety Equivalent to standard Standard / NAC biopsy required Skin flap Elevated, thin (<5mm) Not elevated / Same as SSM Recurrence at skin ~1–2% Baseline / ~1–2% at NAC Use Most breast cancers Historical / Prophylactic, early cancer Tumour distance Any (NAC excised) N/A / >2cm from NAC required FIG 03 — SSM incision options Incision Description Advantage Periareolar Around NAC Short scar, good access Periareolar + lateral J or L extension Larger breasts, axillary access Inframammary fold Along IMF crease Hidden scar, natural position Lateral radial Axillary approach SLNB via same incision Wise pattern T-shape for large/ptotic Simultaneous reshaping Vertical Inferior pole extension Moderate ptosis correction Endoscopic port Minimal incisions Emerging technique Robotic-assisted Robot port sites Minimal external scarring Standard ellipse Traditional horizontal If skin involvement present FIG 04 — Skin-sparing mastectomy pathway 1 Mastectomy decision (tumour location, size, 2 SSM vs NSM vs standard (NAC involved? tumour 3 Pre-op marking (incision design + skin 4 SSM with SLNB (same anaesthetic) 5 Immediate reconstruction (expander or flap) 6 Adjuvant treatment as indicated FIG 05 — SSM technique combinations SSM + immediate tissue expander SSM + immediate DIEP flap SSM + immediate LD flap Prophylactic bilateral SSM (BRCA) SSM conversion from planned NSM Skin-sparing with ADM support FIG 06 — Key statistics Skin-envelope recurrence rate ~1–2% [1] Equivalent oncological outcomes to standard mastectomy [2] Superior cosmetic outcomes vs standard mastectomy [3] Most commonly combined with immediate reconstruction [4] References 1. Simmons RM et al. SSM recurrence rates. Ann Surg Oncol 1999 2. Spiegel AJ et al. SSM oncological safety. Cancer 2003 3. Lanitis S et al. SSM cosmesis review. Breast 2010 4. NICE NG101. Early breast cancer 2023 5. Carlson GW et al. SSM 20-year experience. Plast Reconstr Surg 2011 Clinically authored by Dr Fiona Tsang-Wright , FRCS (Gen Surg) GMC 4549831 · ORCID 0000-0003-4801-026X
Visual Reference · Skin-sparing mastectomy
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Definition
A skin-sparing mastectomy is a mastectomy that removes the breast tissue and the nipple but preserves most of the breast skin envelope, allowing immediate reconstruction with a more natural-looking shape than a simple mastectomy.
Comparable Local recurrence rate vs nipple-sparing mastectomy in selected patients 1 2

Common questions The questions patients ask first

Why am I being offered SSM rather than NSM?
Usually because something about your case makes nipple preservation less suitable — the cancer's position close to the nipple, breast size or shape that complicates nipple preservation, or a clinical concern with nipple involvement. The specific reason in your case is explained at consultation.
Will I have a scar around my breast?
Yes — the incision is around the areola2, often extended laterally for access. Once the reconstruction is in place, the scar is the natural circle that would appear if the areola were tattooed back later. The scar fades over 12 months.
Can I have nipple reconstruction later?
Yes. Nipple reconstruction is a small day-case procedure typically done 6–12 months2 after the original mastectomy, followed by areolar tattooing a few months later. The combination produces a convincing result for most patients.
Will the cosmetic result be obvious in clothing?
Most patients with SSM and immediate reconstruction look entirely normal in fitted clothing, including most swimwear. The chest contour is preserved by the reconstruction. Without nipple reconstruction, very fitted or thin clothing may show a difference; with nipple reconstruction, this is usually not visible.

A skin-sparing mastectomy is a mastectomy that removes the breast tissue and the nipple but preserves most of the breast skin envelope, allowing immediate reconstruction with a more natural-looking shape than a simple mastectomy.

SSM sits between simple mastectomy (which removes skin, nipple, and breast tissue) and nipple-sparing mastectomy (which preserves both skin and nipple). The preserved skin envelope is filled with an implant or autologous tissue at the same operation, giving a better cosmetic result than reconstruction performed on a tightly closed chest wall.

Orientation Why you might be reading about this

You may have been told skin-sparing mastectomy is being recommended, or you are weighing up the differences between mastectomy types. SSM is the modern default for mastectomy with immediate reconstruction in most situations where nipple-sparing is not suitable. This page explains what is preserved, what is removed, and how it compares to the alternatives.

Related terms: Mastectomy · Nipple-sparing mastectomy · Immediate reconstruction · Implant reconstruction · DIEP flap

How it differs How SSM differs from other mastectomy types

Simple mastectomy Skin-sparing mastectomy Nipple-sparing mastectomy
Breast tissue removed Yes Yes Yes
Skin envelope preserved No Yes Yes
Nipple-areolar complex preserved No No Yes
Suitable for immediate reconstruction Possible but harder Yes Yes — best cosmetic result

SSM is the most common modern mastectomy type when immediate reconstruction is part of the plan3. The skin envelope is preserved through a smaller incision (usually around the areola or in a pattern that allows the nipple to be removed while keeping the rest of the skin intact)1. The breast tissue and the nipple are removed. The mastectomy cavity is then filled with an implant or autologous tissue2.

Suitability When SSM is the right choice

SSM is offered when:

  • Immediate reconstruction is planned. The preserved skin envelope is what makes immediate reconstruction give a good result.
  • Nipple-sparing mastectomy is not suitable — for example, the cancer is close to the nipple, or the breast anatomy is not suitable for nipple preservation.
  • The patient prefers nipple removal at the time of surgery — some patients choose SSM over NSM for personal reasons even where NSM might be technically possible.

For cancer cases, SSM is suitable when the cancer can be removed safely with the breast tissue and nipple, but where the rest of the skin is not involved.

The procedure What the operation involves

  • Anaesthetic: general anaesthetic.
  • Incision pattern: typically an ellipse around the areola (taking the nipple), sometimes with extensions for access. The incision is designed to give a hidden scar after reconstruction.
  • Length of operation: depends on the reconstruction. SSM with implant-based reconstruction typically takes 2–3 hours per side1; with DIEP, 6–8 hours.
  • Hospital stay: 1–2 nights for implant-based reconstruction; 4–5 nights for DIEP.
  • Reconstruction: almost always immediate.

For more on the practice’s pathway, see mastectomy.

Nipple reconstruction Nipple reconstruction — the second-stage option

A patient who has had SSM and wants the appearance of a nipple can have nipple reconstruction at a later operation, typically 3–6 months after the original mastectomy (longer if radiotherapy is planned — usually 6–12 months after radiotherapy completes)2:

  • A small day-case procedure under local or general anaesthetic.
  • The reconstructed nipple is built from a small piece of the surrounding tissue, sometimes augmented with a graft.
  • A few months later, areolar tattooing by a specialist tattoo artist creates a realistic colour and texture.

The result of reconstruction-plus-tattoo can be very convincing — patients often describe it as preferable to the alternative of NSM with a poorly sensate or asymmetric original nipple.

Outcomes Cosmetic outcomes

The cosmetic outcome of SSM with immediate reconstruction is usually:

  • Better than simple mastectomy with delayed reconstruction (where the skin envelope has not been preserved).
  • Less natural than nipple-sparing mastectomy with immediate reconstruction (where the original nipple is preserved).
  • Improved with nipple reconstruction and tattooing at a later operation.

The exact result depends on the reconstruction type (implant or autologous), the patient’s anatomy, and any radiotherapy that follows.

At consultation What to discuss at consultation

If SSM is being considered:

  • Why SSM rather than nipple-sparing — the cancer’s position, anatomy, or other factors that make NSM less suitable.
  • The reconstruction option — implant or autologous, decided alongside SSM.
  • Nipple reconstruction at a later stage — what the timing and appearance look like.
  • The realistic cosmetic outcome — usually shown at consultation with photographs of a range of results.

Resources Further reading

Sources & guidance

Every figure on this page is anchored to a published source. Tap a number in the text or below to jump to the reference.

  1. guidance Association of Breast Surgery (ABS). Best Practice Guidelines: surgical management of breast cancer. London: ABS. 2022 https://www.nice.org.uk/guidance/ng101 Cited for: UK best-practice for skin-sparing mastectomy and incision design; same-stage reconstruction principles.
  2. guidance Association of Breast Surgery / British Association of Plastic, Reconstructive and Aesthetic Surgeons. Oncoplastic Breast Reconstruction: Guidelines for Best Practice. London: ABS / BAPRAS. 2021 https://associationofbreastsurgery.org.uk/professionals/information-hub/guidelines/2021/oncoplastic-breast-reconstruction-guidelines-for-best-practice Cited for: Standards for SSM with immediate reconstruction; staged nipple reconstruction at 6–12 months; cosmetic considerations.
  3. meta analysis Lanitis S, Tekkis PP, Sgourakis G, Dimopoulos N, Al Mufti R, Hadjiminas DJ. Comparison of skin-sparing mastectomy versus non-skin-sparing mastectomy for breast cancer: a meta-analysis of observational studies. Annals of Surgery. 2010 ;251(4):632–639 doi:10.1097/SLA.0b013e3181d35bf8 Cited for: Oncological equivalence of SSM to non-skin-sparing mastectomy; rationale for SSM as the modern default when immediate reconstruction is planned.