Subcutaneous mastectomy for primary breast cancer and ductal carcinoma in situ

doi:10.1016/S0748-7983(97)90912-4

European Journal of Surgical Oncology (EJSO)

Volume 23, Issue 4, August 1997, Pages 343-347

https://doi.org/10.1016/S0748-7983(97)90912-4 Get rights and content

Subcutaneous mastectomy (SCM) has been performed in 323 patients with invasive breast cancer or ductal carcinoma in situ (DCIS) over the last 20 years. This paper assesses the oncological safety of this operation with particular reference to local recurrences (LR) in the skin flaps. LR was assessed in the 134 patients who did not receive post-operative irradiation to the flaps and were followed up for a minimum of 30 months. The rates of LR were similar for SCM (16%) and for women who underwent simple mastectomy without post-operative irradiation (SM) for invasive cancer (14%) over the same time period, both overall and after prognostic stratification. In DCIS LR was only found in women treated with SCM. Four of the five recurrences (from 33 women) were in the nipple and later in the series patients with microscopic tumour involvement in the nipple received prophylactic irradiation to the nipple only; five patients treated in this way have not suffered LR. Subcutaneous mastectomy followed by insertion of a prosthesis is a safe alternative to mastectomy, since it carries no higher risk of LR. It is the simplest form of reconstruction in those proceeding to silicone implant and has the potential of achieving an excellent cosmetic result. Failure does not compromise the chance of more complex reconstruction procedures.

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Cited by (40)

4-24 Nipple-Sparing Mastectomy for Breast Cancer and Risk Reduction: Oncologic or Technical Problem?
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The idea of subcutaneous or nipple-sparing mastectomy is not novel. The procedure has been publicized in published reports by several other authors.3–5 However, as Sacchini and colleagues point out, there are important differences between the subcutaneous mastectomy and the current nipple-sparing procedure.
Management of the BRCA Mutation Carrier or High-Risk Patient
2007, Clinics in Plastic Surgery
Citation Excerpt :
Subcutaneous mastectomy is synonymous for a mastectomy that spares the nipple–areolar complex. Breast cancer can arise following subcutaneous mastectomy performed for either breast cancer treatment or for prophylaxis [74–78], with documented cases of cancer recurrence arising in the breast tissue associated with the nipple [79]. In contrast to a total mastectomy with removal of 95% to 99% of the breast tissue, a subcutaneous mastectomy may only remove 95% of the breast tissue, with residual tissue in the axillary tail, breast flaps, and beneath the nipple [80].
Areola-sparing mastectomy: Defining the risks
2005, Journal of the American College of Surgeons
Time to reconsider subcutaneous mastectomy for breast-cancer prevention?
2005, Lancet Oncology
Genetic testing for women at increased risk of developing breast cancer has moved from the research setting to become part of established clinical practice. By testing for inherited mutations in BRCA1 and BRCA2, we are identifying more and more women who have an 80% or more lifetime risk of developing breast cancer. Since the discovery of BRCA1 in 1994, several clinical studies have led to strategies for reducing the risk of developing breast cancer, including prophylactic mastectomy, prophylactic oophorectomy, and preventive tamoxifen. We believe that in 2005, all prophylactic options, including subcutaneous and total mastectomy should be discussed and made available to women who find themselves unfortunate enough to have inherited a BRCA mutation.
Two staged breast reconstruction following prophylactic bilateral subcutaneous mastectomy
2005, British Journal of Plastic Surgery
Citation Excerpt :
By doing this, on an average, most of the breast parenchyma can be removed and it is comparable to the extirpation achieved with radical mastectomies.19 Subcutaneous mastectomy is a safe alternative to total mastectomies performed for early primary invasive breast cancer (not located under the nipple) and multifocal DCIS, since it caries no higher risk of local recurrence.20 The probability of developing, at a later date, an invasive cancer in the remaining tissue and particularly under the nipple is insignificant.
The aim of this retrospective study was to evaluate the results in patients who underwent bilateral subcutaneous mastectomy (BSCM) for prophylaxis against invasive breast cancer. All patients were operated on with the same protocol regarding indications and surgical method. Reconstruction was completed in two stages with tissue expanders and permanent round or shaped rough textured gel filled silicone implants. The study includes 52 patients with a mean age of 39.5 years operated on in the period 1991–2000; the period of follow-up ranged between 3 and 12 years with a mean of 7. In this series, not a single case of invasive cancer developed, and the aesthetic results are considered very satisfactory. This data strengthens the case of subcutaneous mastectomy as a valid prophylactic operation.
A comparative study of envelope mastectomy and immediate reconstruction (EMIR) with standard latissimus dorsi immediate breast reconstruction
2004, European Journal of Surgical Oncology
Background. Latissimus dorsi breast reconstruction has problems with scars at the donor site and on the reconstructed breast. We report the feasibility and aesthetic results of Envelope Mastectomy and Immediate Reconstruction (EMIR), which utilises a single lateral mammary fold incision.
Patients and methods. Between 2001 and 2002, 20 EMIRs were performed in 19 patients, one as a staged bilateral procedure. Twenty consecutive patients, matched for body habitus, who had undergone standard latissimus dorsi breast reconstruction by the same surgeon from 1996 to 2000 were used as controls. Patient satisfaction was assessed using a validated Body Image Scale. Standard post-operative photographs were scored by three independent observers.
Results. Length of stay and complication rates were equivalent between both groups. Cosmetic self-assessment scores on the Body Image Scale and scores by the independent observers were satisfactory for both groups but no statistically significant difference was observed between groups.
Conclusions. EMIR is a technically feasible and cosmetically acceptable method of immediate breast reconstruction.

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Original articleSubcutaneous mastectomy for primary breast cancer and ductal carcinoma in situ

Eur J Cancer

Local recurrence after simple mastectomy

Br J Surg

The role of postoperative irradiation in carcinoma of the breast

Cancer

Frequency of anatomical distribution and management of local recurrence after a definitive therapy for breast cancer

Cancer

The role of radiotherapy following total mastectomy for patients with early breast cancer

World J Surg

The Nottingham Prognostic Index in primary breast cancer

Br Cancer Res Treatment

Original article
Subcutaneous mastectomy for primary breast cancer and ductal carcinoma in situ