Outcomes after Total Skin-sparing Mastectomy and Immediate Reconstruction in 657 Breasts

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 04/2012; 19(11):3402-9. DOI: 10.1245/s10434-012-2362-y
Source: PubMed


Total skin-sparing mastectomy (TSSM), a technique comprising removal of all breast and nipple tissue while preserving the entire skin envelope, is increasingly offered to women for therapeutic and prophylactic indications. However, standard use of the procedure remains controversial as a result oft concerns regarding oncologic safety and risk of complications.
Outcomes from a prospectively maintained database of patients undergoing TSSM and immediate breast reconstruction from 2001 to 2010 were reviewed. Outcome measures included postoperative complications, tumor involvement of the nipple-areolar complex (NAC) on pathologic analysis, and cancer recurrence.
TSSM was performed on 657 breasts in 428 patients. Indications included in situ cancer [111 breasts (16.9 %)], invasive cancer [301 breasts (45.8 %)], and prophylactic risk-reduction [245 breasts (37.3 %)]. A total of 210 patients (49 %) had neoadjuvant chemotherapy, 78 (18.2 %) had adjuvant chemotherapy, and 114 (26.7 %) had postmastectomy radiotherapy. Nipple tissue contained in situ cancer in 11 breasts (1.7 %) and invasive cancer in 9 breasts (1.4 %); management included repeat excision (7 cases), NAC removal (9 cases), or radiotherapy without further excision (4 cases). Ischemic complications included 13 cases (2 %) of partial nipple loss, 10 cases (1.5 %) of complete nipple loss, and 78 cases (11.9 %) of skin flap necrosis. Overall locoregional recurrence rate was 2 % (median follow-up 28 months), with a 2.4 % rate observed in the subset of patients with at least 3 years' follow-up (median 45 months). No NAC skin recurrences were observed.
In this large, high-risk cohort, TSSM was associated with low rates of NAC complications, nipple involvement, and locoregional recurrence.

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    • "Mx; mean FU ¼ 30 m 2.7% SSM vs. 3.9% Mx Nava et al., 2011 13 77 SSM; median FU ¼ 36 m 0.5%/year Sheikh et al., 2011 74 177 SSM vs. 249 Mx; mean FU ¼ 28 m 1.1% SSM vs. 0.8% Mx (non-significant); [positive or close margin, 29% SSM vs. 12% Mx; p < 0.01] Peled et al., 2012 73 126 SSM; median FU ¼ 28 m 2.4% Romics et al., 2012 24 207 SSM; median FU ¼ 119(14e163) m 2.9% (8.2% loco-regional, 10.6% systemic recurrence) further if frozen section was used. They also noted that majority recurrences were in the NAC which could be easily excised under local anaesthesia. "
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