Breast Oncology

Annals of Surgical Oncology

, Volume 19, Issue 11, pp 3402-3409

Outcomes after Total Skin-sparing Mastectomy and Immediate Reconstruction in 657 Breasts

  • Anne Warren PeledAffiliated withDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California
  • , Robert D. FosterAffiliated withDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of California
  • , Allison C. StoverAffiliated withDepartment of Surgery, Carol Franc Buck Breast Cancer Center, University of California
  • , Kaoru ItakuraAffiliated withDepartment of Surgery, Carol Franc Buck Breast Cancer Center, University of California
  • , Cheryl A. EwingAffiliated withDepartment of Surgery, Carol Franc Buck Breast Cancer Center, University of California
  • , Michael AlvaradoAffiliated withDepartment of Surgery, Carol Franc Buck Breast Cancer Center, University of California
  • , E. Shelley HwangAffiliated withDepartment of Surgery, Duke University Medical Canter
  • , Laura J. EssermanAffiliated withDepartment of Surgery, Carol Franc Buck Breast Cancer Center, University of California Email author 

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Abstract

Background

Total skin-sparing mastectomy (TSSM), a technique comprising removal of all breast and nipple tissue while preserving the entire skin envelope, is increasingly offered to women for therapeutic and prophylactic indications. However, standard use of the procedure remains controversial as a result oft concerns regarding oncologic safety and risk of complications.

Methods

Outcomes from a prospectively maintained database of patients undergoing TSSM and immediate breast reconstruction from 2001 to 2010 were reviewed. Outcome measures included postoperative complications, tumor involvement of the nipple–areolar complex (NAC) on pathologic analysis, and cancer recurrence.

Results

TSSM was performed on 657 breasts in 428 patients. Indications included in situ cancer [111 breasts (16.9 %)], invasive cancer [301 breasts (45.8 %)], and prophylactic risk-reduction [245 breasts (37.3 %)]. A total of 210 patients (49 %) had neoadjuvant chemotherapy, 78 (18.2 %) had adjuvant chemotherapy, and 114 (26.7 %) had postmastectomy radiotherapy. Nipple tissue contained in situ cancer in 11 breasts (1.7 %) and invasive cancer in 9 breasts (1.4 %); management included repeat excision (7 cases), NAC removal (9 cases), or radiotherapy without further excision (4 cases). Ischemic complications included 13 cases (2 %) of partial nipple loss, 10 cases (1.5 %) of complete nipple loss, and 78 cases (11.9 %) of skin flap necrosis. Overall locoregional recurrence rate was 2 % (median follow-up 28 months), with a 2.4 % rate observed in the subset of patients with at least 3 years’ follow-up (median 45 months). No NAC skin recurrences were observed.

Conclusions

In this large, high-risk cohort, TSSM was associated with low rates of NAC complications, nipple involvement, and locoregional recurrence.