What is a Skin-Reducing Mastectomy?

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A skin-reducing mastectomy removes the breast glandular tissue while also reducing excess breast skin at the same operation.

This technique is particularly useful for women with larger and/or ptotic (droopy) breasts who are planning reconstruction. The goal is not only to remove the breast tissue safely, but also to create a smaller, better-shaped skin envelope, which can improve the final breast shape after reconstruction.

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By reducing the skin envelope, the volume that needs to be replaced becomes smaller. This may allow:

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• A smaller implant (if implant reconstruction is planned)

• Smaller flap volume (if autologous reconstruction is planned)

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Improved breast shape and symmetry, especially when a lift or reduction effect is desired

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It may be considered for:

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• Women with large, heavy or droopy breasts needing mastectomy

• Patients who would benefit from a smaller reconstructed breast for comfort and easier long-term surveillance

• Women with symptoms related to breast weight (neck, shoulder, or back discomfort), where a smaller reconstructed breast is preferred

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Can the nipple be preserved?

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In selected patients, the nipple can sometimes be safely preserved to enhance the final aesthetic outcome. However, nipple-sparing skin-reducing mastectomy is more complex because maintaining nipple perfusion is critical. Your surgeon will discuss whether this is appropriate based on breast size, degree of ptosis, tumour location, circulation, smoking history, and other risk factors.

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How is the nipple–areola blood supply preserved?

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The nipple and areola receive blood from two main sources: from the breast tissue underneath and from the skin around it. In a skin-reducing mastectomy, the cut around the areola is carefully performed in a way that preserves the deeper layer of skin and the tiny blood vessels that feed the nipple. This helps keep the nipple well perfused and reduces the risk of healing problems. Because this technique is more complex than a standard nipple-sparing mastectomy, it requires careful planning and precise surgery to protect the nipple’s blood supply.

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Before the Procedure

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• Your surgeon will design the most appropriate skin-reduction pattern based on your pre-operative consultation, your breast size and shape, and your desired final breast size and volume. This is an important opportunity to plan the “new breast envelope”, including the position of the nipple-areola complex (if nipple preservation is planned) and the overall breast size and shape.

• Please bring your breast imaging and reports if they were performed outside the hospital.

• On the day of surgery, the final surgical plan will be confirmed, including lymph node surgery (if required) and the planned type of reconstruction.

• You will arrive fasting as instructed, and the incision sites will be carefully marked before going to theatre. These markings are essential for achieving the best possible breast shape and symmetry.

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During the Procedure

 

• The surgery is performed under general anaesthetic, so you will be asleep throughout.

• The mastectomy removes the breast tissue.

• At the same time, the excess breast skin is reduced using a planned incision pattern, similar to reduction techniques.

• Common incision patterns include:

  • Vertical (“lollipop”) pattern

  • Wise pattern (“anchor” or inverted-T) pattern

• If indicated, a sentinel lymph node biopsy or axillary lymph node dissection will be performed through the same or a nearby incision.

• Immediate reconstruction is performed using an implant, tissue expander, or autologous tissue (flap).

• One small drains are placed to remove fluid and reduce swelling.

• The incision is closed with dissolvable sutures and sealed with surgical glue.

• Most patients stay in hospital for one to two nights.

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After the Procedure

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• You’ll wake up in the recovery area before being transferred to the ward.

• Nursing staff will monitor your comfort, wound sites, and nipple perfusion.

• The drains usually remain for a few days and are removed when drainage is minimal.

• You surgical bra will be worn from the day after surgery, once we confirms that nipple perfusion is satisfactory.

• The bra should then be worn day and night for at least one month to provide support and reduce swelling.

• Your dressing is waterproof, and you can shower from the day after surgery.

• You’ll be encouraged to perform gentle arm and shoulder exercises to maintain mobility.

• Driving is permitted after your first postoperative review, once movement is comfortable and you are off strong pain medication.

 

Pathology results are usually ready within 7–10 days and will be discussed at your follow-up visit.

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If further treatment is required, such as radiotherapy or hormone therapy, it will be planned once you have recovered.

Possible Risks and Side Effects

 

Although skin-reducing mastectomy is generally safe, possible risks include but not limited to:

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• Bleeding or haematoma

• Infection

• Fluid collection (seroma)

• Partial or complete nipple or skin flap necrosis if blood flow is reduced

• Delayed wound healing

• Changes in nipple sensation

• Implant-related complications (if reconstruction performed)

• Shoulder stiffness or tightness

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Benefits of Skin-Reducing Mastectomy

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• Reduces excess breast skin to create a smaller, better-shaped breast envelope

• Facilitates reconstruction by reducing the space that needs to be filled

• May allow smaller implants or smaller flap volumes

• Improves breast shape in women with large or droopy breasts

• Can be combined with immediate reconstruction in the same operation

• May improve comfort in women who prefer a smaller breast after reconstruction

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Key Points

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• Key Points

• Removes breast tissue and also reduces excess skin at the same operation

• Ideal for women with moderate to large, droopy breasts planning reconstruction

• Often combined with immediate reconstruction

• Nipple preservation may be possible in selected patients, but adds complexity and requires careful perfusion monitoring

• You can usually shower from the day after surgery

• Wear the surgical bra continuously for at least one month once applied

• Driving permitted after your first postoperative review

• Typical hospital stay: one to two nights, with small drains in place for a few days

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