Minimal Scar Mastectomy (MSM), a novel technique of nipple-
sparing mastectomy without reconstruction, is enabling
patients at KK Women’s and Children’s Hospital (KKH) with
breast cancer to conserve their nipple-areolar complex with
minimal post-surgical scarring.
Breast cancer is the top cancer affecting women worldwide,
and develops when cells in the breast begin to grow out of
control. In Singapore, it is estimated that one in 14 women
develop breast cancer before the age of 75.
Pioneered by Dr Lim Geok Hoon, Senior Consultant, KK Breast Department, KKH, MSM has been introduced for select
patients at KKH with breast cancer since March 2017. Arising
from a combination of nipple-sparing mastectomy and
the round block technique (an oncoplastic technique), MSM
provides patients with an alternative to the long transverse
chest scar associated with traditional mastectomy, with a more
cosmetically pleasant concealed scar. MSM also enables the
preservation of the nipple-areolar complex – which has been
shown to improve the psychological well-being of patients.
In most cases of treatable breast cancer, surgery of the breast
is usually required, and would involve either breast conservation
combined with radiotherapy, or a mastectomy with or
Traditionally, to spare the nipple during mastectomy, reconstruction
would be mandatory to support the overlying breast
skin envelope after the mastectomy has been performed.
This would involve the use of implants or the patient’s own
tissue, usually from the back or abdomen, which increases the
duration and costs associated with the surgery.
During MSM, the skin around the areola is pre-operatively
outlined to estimate the amount of breast skin to be removed.
Thereafter, this excess breast skin is removed and
mastectomy is performed using an incision around the areola,
while preserving the nipple-areolar complex. The areolar
wound is then closed in the same fashion as the round
This is the first reported surgical technique that is able to preserve
the nipple-areolar complex in a mastectomy without
the need for reconstruction. Should the patient choose to go
for reconstruction in the future, the cosmetic outcome will
also be better compared to a traditional mastectomy, since
the transverse scar associated with the latter is avoided.
The eligibility criteria for MSM includes small breasts, with no
evidence of cancer involving the nipple-areolar complex or a
large area of breast skin. They would also need to have opted
for mastectomy without reconstruction, and have the desire
to conserve their nipple-areolar complex.
Although mastectomy with reconstruction will inevitably result
in a better cosmesis as compared to without reconstruction,
the decision to embark on reconstruction remains a very
Given the high rate of patients with breast cancer who choose
mastectomy without reconstruction locally, as well as a higher
prevalence of women with smaller breasts in the Asian population,
MSM can certainly be an option to consider for this
group of breast cancer patients, allowing suitable patients to
conserve their nipple-areolar complex with less scarring.
Patients diagnosed with breast cancer who are
considering to undergo a minimal scar mastectomy can
contact KKH at +65 6294 4050 for a consultation at the
KK Breast Centre, which is a part of the SingHealthDuke-NUS Breast Centre.
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