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Mastectomy has become less invasive. The radical mastectomy published by William Halsted in1894 included resection of skin, gland, the pectoral muscles and axillary lymph nodes en bloc. This approach was partially due to the late and extensive stages of the disease. Nowadays most mastectomies are performed as nipple-sparing mastectomies (NSM), leaving the skin and the nipple intact. It was shown that the risk for recurrence is not much increased in the right indications. Skin- and nipple-sparing mastectomies (SSM and NSM) have shifted the paradigm in breast reconstruction. Leaving the skin intact requires a primary reconstruction and involves the plastic surgeon early in the surgical and oncological concept.
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