Extract

“If you want something new, you have to stop doing something old.”1

Peter Drucker

Plastic surgeons are always on the lookout for something new. The Halsted radical mastectomy was modified by Patey when it was determined that routine removal of the pectoralis major muscle offered no therapeutic benefit when uninvolved with disease.2,3 The modified radical mastectomy evolved into the skin-sparing mastectomy.4 More recently, the skin-sparing mastectomy has evolved into the nipple-sparing mastectomy (NSM), Scott Spear’s great contribution for the treatment of selected patients who require a mastectomy for cancer treatment or prophlaxis.5

With each step, plastic surgeons have adjusted their technique to permit improvements in the care and aesthetic results available to their patients. It’s safe to say that NSM has provided an unparalleled opportunity to eliminate the distinctions between aesthetic and reconstructive breast surgery. We now reside in a world where it’s possible to say that all breast surgery can be “aesthetic.” With the advent of NSM, latest generation breast devices, acellular dermal matrix, and autologous fat grafting we can reassure women, especially those contemplating prophylactic mastectomy, that in most instances we can offer an aesthetic upgrade over their existing appearance. The remaining caveat is that erogenous nipple sensibility will be lost in the process.

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