Subcutaneous mastectomy.

Subcutaneous mastectomy is a compromise surgical procedure for the precancerous breast. We do not think that total mastectomy is indicated in such patients. The effect of the small cuff of tissue beneath the areola more than compensates for the minimal additional risk by leaving a more attractive and eminently more acceptable breast. In the past six years, in more than 150 patients, use of the fanned muscle flap has not only restored warmth and thickness to the thin breast envelope but provided additional suture-line protection. The layered closure has prevented implant exposure even with traumatic or seromatous skin separation on several occasions. Placement of the incision lateral to the areola or entirely above the areola prevents unnecessary visible scarring with most clothing and provides additional protection for the incision line since it overlies the muscle flap. With increasing experience using this procedure, we now attempt to limit all our incisions to the supraareolar hemicircle. Neither incision limits visualization of the axilla or of the inevitable bleeding in this area.