Skin-sparing mastectomy represents a new surgical approach that allows a mastectomy while preserving the natural skin envelope of the breast. It facilitates immediate breast reconstruction using an implant or myocutaneous flap, resulting in excellent cosmesis. A PubMed database literature search was performed. Skin-sparing mastectomy is an oncologically safe technique in selected cases; T1/T2, multicentric tumors, ductal carcinoma in situ, and prophylactic mastectomies are particularly suited to this technique. Further research is required to confirm oncologic safety in T3 tumors. In selected cases, the nipple-areola complex can be preserved. A modification of skin-sparing mastectomy includes the removal of the nipple while preserving the areola. The balance of evidence suggests that skin-sparing mastectomy does not increase the risk of locoregional recurrence. Furthermore, it does not delay adjuvant therapies. Contraindications to skin-sparing mastectomy approaches include inflammatory breast cancer and extensive skin involvement by tumor. Preoperative and postoperative radiotherapy are not a contraindication to skin-sparing mastectomy.
