Original Articles

Annals of Surgical Oncology

, Volume 10, Issue 2, pp 102-107

First online:

Skin Involvement in Invasive Breast Carcinoma: Safety of Skin-Sparing Mastectomy

  • Chiu M. HoAffiliated withDepartment of Surgery, Division of Plastic Surgery (CMH, WYC), Kwong Wah HospitalDivision of Plastic Surgery, Department of Surgery, Kwong Wah Hospital Email author 
  • , Colin K. L. MakAffiliated withDepartment of Pathology (CKLM), Kwong Wah Hospital
  • , Yvonne LauAffiliated withDepartment of Breast Center (YL, MCMC, WKH), Kwong Wah Hospital
  • , Wing Y. CheungAffiliated withDepartment of Surgery, Division of Plastic Surgery (CMH, WYC), Kwong Wah Hospital
  • , Miranda C. M. ChanAffiliated withDepartment of Breast Center (YL, MCMC, WKH), Kwong Wah Hospital
  • , Wai K. HungAffiliated withDepartment of Breast Center (YL, MCMC, WKH), Kwong Wah Hospital

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Abstract

Background:There is concern about the oncological safety of preserving most of the breast skin in skin-sparing mastectomy (SSM). Most supportive evidence for SSM evaluates the local recurrence rate on clinical follow-up.

Methods:The skin and 10 mm of the subcutaneous tissue of 30 total mastectomy specimens were studied with a step-serial sectioning technique. The incidence and mode of involvement of the skin and subcutaneous tissue were recorded in detail. This was correlated with other clinical and pathologic parameters.

Results:The incidence of skin involvement outside the nipple-areola complex was 20% (6 of 30). This was significantly related to the clinical T stage, site of the tumor, skin tethering, pathologic tumor size, and perineural infiltration. When the effects of both skin and subcutaneous tissue involvement were considered, the incidence of skin-flap involvement outside the nipple-areola complex was 23% (7 of 30). The significant parameters related to skin-flap involvement were skin tethering (75% vs. 15%; P < .05), pathologic tumor size (P < .03), and perineural infiltration (63% vs. 9%; P < .01).

Conclusions:It would be oncologically safe to perform SSM in T1 and T2 tumors, because the chance of skin involvement is small. It is safe to preserve the skin overlying the tumor if there is no skin tethering.

Key Words:

Skin involvement Invasive breast carcinoma Skin-sparing mastectomy Safety