Background: Over a third of women with ductal carcinoma in situ (DCIS) will require mastectomy with an increasing demand for immediate reconstruction, requiring skin-sparing or nipple-sparing mastectomy (SSM or NSM). We have previously demonstrated that loco-regional recurrence (LRR) following skin sparing mastectomy for DCIS was higher than for simple mastectomy. There is a need to provide
... [Show full abstract] adequate information on LRR to patients to facilitate informed consent.
Methods: We undertook a retrospective analysis, collecting clinic-pathological data for all patients at single high-volume unit, who underwent a mastectomy for DCIS between 2000 and 2016. The primary aim was to compare LRR in simple mastectomy (SM) vs SSM.
Results: 336 patients underwent a mastectomy for pure DCIS (147 SM vs 189 SSM/NSM). Other than median age (51 years vs 58 years, p=.0.004), there was no difference in other clinico-pathological variables between the SM and SSM/NMS groups, including grade of DCIS (HG DCIS 76.6% vs 72.3%, p=0.457) and resection margins of >1mm (16.4% vs 18.5%, p=0.726). At a median follow-up of 72 months, there were 13 LRRs, all of which occurred within the SSM/NSM cohort (6.9%). This difference was more apparent for patients with high grade DCIS (0 vs 8.8%, p<0.001).
Conclusions: LRR was higher after SSM/NSM than SM despite no differences in clinic-pathological factors that would influence recurrence. Patients should be counselled with regards the potential greater risk of LRR after SSM than simple mastectomy and there may be a role in for post-reconstruction mammography.
