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.
"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. "
[Show abstract][Hide abstract] ABSTRACT: AIMS: Skin Sparing Mastectomy (SSM) is widely practised now in major centres which manage large numbers of breast cancer but anxiety still exists over the safety of SSM both from oncological and aesthetic points of view. We aim to review literature to date in SSM and summarise and discuss the current evidence. METHODS: Studies were identified by an online search of the English language literature in the PubMed database till April 2012 followed by an extensive review of bibliographies from relevant articles. RESULTS: There is abundance of evidence with regards to the safety of SSM both oncologically and aesthetically especially in immediate breast reconstruction. The use of SSM technique broadens the repertoire of oncoplastic techniques and at the same time facilitates such techniques by preserving patient's native skin and anatomical landmarks. CONCLUSIONS: SSM is a safe technique providing better cosmetic outcome without compromising oncological safety as per the current evidence. However, prospective data collection of its application in various newer types of reconstructions, and continuing long-term follow-up of current data series would be prudent to evaluate long-term outcomes.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 01/2013; 39(4). DOI:10.1016/j.ejso.2012.12.015 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: One of the most poorly understood clinical diagnoses in breast cancer is ductal carcinoma in situ (DCIS), which now accounts for almost one third of all mammographically detected malignancies. Detection and diagnosis of DCIS have improved, and mature data from randomized controlled trials of lumpectomy for DCIS have provided some measure of the magnitude of benefit to be derived from adjuvant treatments. The past 5 years have seen the emergence of molecular prognostic tools, which together with clinical factors have the potential to allow better selection of individualized therapies for these heterogeneous lesions. Ongoing and future research to identify which patients with DCIS can be safely managed with active surveillance are underway and will create opportunities to better understand the biology of this disease, thereby informing treatment strategies that are more closely aligned with the invasive potential of specific DCIS subtypes.
Current Breast Cancer Reports 06/2013; 5(2). DOI:10.1007/s12609-013-0109-9
[Show abstract][Hide abstract] ABSTRACT: As genetic testing to identify hereditary susceptibility for breast cancer becomes more widely available, interest in prophylactic mastectomy is becoming more popular. Patients with unilateral breast cancer are also pursuing prophylactic contralateral mastectomy for its risk-reducing and symmetry benefits. This review discusses the selection of candidates for prophylactic mastectomy, its benefits, and data on effectiveness of this surgery.
Current Breast Cancer Reports 06/2013; 5(2). DOI:10.1007/s12609-013-0110-3
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