Short communicationThe use of skin sparing mastectomy in the treatment of breast cancer: The Emory experience
Introduction
The term skin sparing mastectomy (SSM) was first used by Toth and Lappert in 1991 [1]. They described preoperative planning of mastectomy incisions in an attempt to maximize skin preservation and facilitate breast reconstruction. In that same year, Kroll, et al., reported their experience with 100 breast cancer cases treated with SSM and immediate reconstruction [2]. There was one local recurrence (LR) noted with an average follow-up of 23.1 months.
The operation is increasingly used to treat patients with breast cancer. It removes the breast, nipple–areola complex, previous biopsy incisions, and skin overlying superficial tumors [3]. Preservation of the inframammary fold and native skin greatly enhances the aesthetic results of immediate breast reconstruction. Data indicates that the LR rate is similar to conventional mastectomy [4], [5], [6], [7]. Long-term follow-up of the use of SSM in the treatment of breast cancer is presented to determine the impact of LR after SSM on survival.
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Patients and methods
A retrospective review of 539 consecutive patients treated for 565 cases of breast cancer by SSM and immediate reconstruction from 1/1/89 through 12/31/98 at Emory University Hospital was performed. Individual records were analyzed for demographic, oncologic, and reconstructive data. The American Joint Committee on Cancer (AJCC) staging system for breast cancer was used. A SSM removed the breast, nipple–areola complex, skin overlying superficial tumors, and previous incisions. The native skin
Results
The mean patient age at cancer diagnosis was 48.4 years. The AJCC pathological staging for the 565 cases of breast cancer was Stage 0 175 (31%), Stage I 135 (23.9%), Stage II 173 (30.6%), Stage III 54 (9.6%), Stage IV 8 (1.4%), and recurrent 20 (3.5%) (Fig. 2). The mean follow-up was 65.4 months (median 61.6 months). Five patients were lost to follow-up. The distribution of SSM types Type I 186 (33%), Type II 292 (52%), Type III 40 (7%), and Type IV 47 (8%). There was no correlation between the
Discussion
The use of the SSM in the treatment of invasive cancer is based on our growing understanding of the tumor biology of LRs. All forms of mastectomy, whether radical, modified radical, or skin sparing leave residual breast tissue. The differences are in terms of the microscopic breast tissue left behind in the skin and the inframammary fold. The breast is supported by Cooper's “ligaments”, which are peripheral projections of breast tissue in fibrous processes that fuse with the superficial layer
Conclusions
LRs after SSM are influenced by advanced tumor stage and the absence of estrogen receptor expression. High tumor grade and lymphovascular invasion are independent predictors of LR. LR of breast cancer after SSM is not always associated with systemic relapse. Patients with early stage disease may be salvaged with surgical resection and radiation therapy.
References (15)
- et al.
Modified skin incisions for mastectomythe need for plastic surgical input in preoperative planning
Plastic and Reconstructive Surgery
(1991) The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast
Surgery Gynecology & Obstetrics
(1991)Skin sparing mastectomyanatomic and technical considerations
American Surgeon
(1996)Skin sparing mastectomyoncological and reconstructive considerations
Annals of Surgery
(1997)Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer
Annals of Surgery
(2002)Presentation, treatment, and outcome of local recurrence afterskin-sparing mastectomy and immediate breast reconstruction
Annals of Surgical Oncology
(1998)Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies
Annals of Surgical Oncology
(1999)
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2018, European Journal of RadiologyCitation Excerpt :SSM is performed not only for prophylactic reasons, but also for breast cancer in case of multicentricity or when postoperative breast irradiation is contraindicated [9]. SSM is supported by the results of a large series of cancer patients who did not show higher failure rates than those with skin-ablating mastectomy [10–13]. Despite several techniques for postoperative nipple reconstruction, the results are often unsatisfactory to the patient [14].
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2014, Gynecologie Obstetrique et FertiliteSurgical and oncological outcome after skin-sparing mastectomy and immediate breast reconstruction
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