Abstract
Background
The oncological safety of skin-sparing mastectomy (SSM) has been the object of several studies.
Methods
From June 2003 to January 2004, 42 breast cancer patients, stage 0 to IIIA, underwent SSM. Before surgery, two lines were drawn on the breast skin, representing SSM and conventional mastectomy incisions. After surgery, the skin flap that would remain after SSM was removed, and immediate breast reconstruction was begun. The presence and amount of remaining glandular breast tissues were histologically evaluated in the skin flap. Terminal ductal lobular units (TDLUs) and residual disease were identified. These data were correlated with other clinical and pathologic parameters by using Fisher’s exact test (P value) and receiver operating characteristic curves.
Results
The prevalence of residual breast tissue in the sample was 59.5%, and the presence of TDLUs was significantly associated with skin flaps thicker than 5 mm. Residual disease was found in 9.5% of the women and was associated with skin flaps >5 mm thick and the presence of TDLUs. There was no significant association between the presence of TDLUs and residual disease with age, body mass index, menopausal status, clinical and pathologic staging, breast volume, mammographic density, neoadjuvant chemotherapy, type of surgery, and presence of an extensive in situ component. The receiver operating characteristic curve showed that as skin flaps decrease in thickness, TDLUs also decrease.
Conclusions
A high prevalence of glandular breast tissue and residual disease in the skin flap was associated with a skin flap thickness >5 mm.
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References
Toth BA, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 1991;87:1048–53
Singletary SE. Skin-sparing mastectomy with immediate breast reconstruction: the M. D. Anderson Cancer Center experience. Ann Surg Oncol 1996;3:411–6
Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames FC. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol 1997;4:193–7
Carlson GW, Bostwick J, Styblo TM, et al. Skin-sparing mastectomy: oncologic and reconstructive considerations. Ann Surg 1997;225:570–78
Medina-Franco H, Vasconez LO, Fix J, et al. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg 2002;235:814–9
Carlson GW. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol 1998;5:101–4
Losken A, Carson GW, Bostwick J, Jones GE, Culbertson JH, Schoemann M. Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience. Plast Reconstr Surg 2002;10:89–97
Newman LA, Kuerer HM, Hunt KK, et al. Presentation, treatment, and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction. Ann Surg Oncol 1998;5:620–6
Kroll SS, Khoo A, Singletary ES, et al. Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg 1999;104:421–5
Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol 1999;6:676–81
Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 1998;102:49–62
Ho CMH, Mak CKL, Lau Y, Cheung WY, Chan MCM, Hung WK. Skin involvement in invasive breast carcinoma: safety of skin-sparing mastectomy. Ann Surg Oncol 2003;10:102–7
Foster RD, Esserman LJ, Anthony JP, Hwang ES, Do H. Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast cancer. Ann Plast Surg 2002;9:462–6
Disa JJ, Cordeiro PG, Heerdt AH, Petrek JA, Borgen PJ, Hidalgo DA. Skin-sparing mastectomy and immediate autologous tissue reconstruction after whole-breast irradiation. Plast Reconstr Surg 2003;111:118–24
Laronga C, Kemp B, Johnston D, Robb GL, Singletary E. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 1999;6:609–13
Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 2003;238:102–7
Pennisi VR, Capozzi A. Subcutaneous mastectomy: an interim report on 1244 patients. Ann Plast Surg 1984;12:340.
Goldman LD, Goldwyn RM. Some anatomical considerations of subcutaneous mastectomy. Plast Reconstr Surg 1973;51:501–5
Barton FE, English JM, Kingsley WB, Fietz M. Glandular excision in total glandular mastectomy and modified radical mastectomy: a comparison. Plast Reconstr Surg 1991;88:389–94
Verheyden CN. Nipple-sparing total mastectomy of large breasts: the role of tissue expansion. Plast Reconstr Surg 1998;101:1494–500
Bland KI, Copeland EM. Princípios gerais da mastectomia. In: Bland KI, Copeland EM, eds. A Mama: Tratamento Compreensivo das Doenças Benignas e Malignas. São Paulo: Manole, 1994:646–61
Carlson GW. Skin sparing mastectomy: anatomic and technical considerations. Am Surg 1996;62:151–5
Haagensen CD. Diseases of the Breast. Philadelphia: WB Saunders, 1986
Beer GM, Varga Z, Budi S, Seifert B, Meyer VE. Incidence of the superficial fascia and its relevance in skin-sparing mastectomy. Cancer 2002;94:1619–25.
Carlson GW, Syblo TM, Lyles RH, et al. Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Ann Surg Oncol 2003;10:108–12
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Torresan, R.Z., Santos, C.C.d., Okamura, H. et al. Evaluation of Residual Glandular Tissue After Skin-Sparing Mastectomies. Ann Surg Oncol 12, 1037–1044 (2005). https://doi.org/10.1245/ASO.2005.11.027
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DOI: https://doi.org/10.1245/ASO.2005.11.027