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Total Skin-Sparing Mastectomy and Immediate Breast Reconstruction: An Evolution of Technique and Assessment of Outcomes

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Total skin-sparing mastectomy (TSSM) with preservation of the breast and nipple-areolar complex (NAC) skin was developed to improve aesthetic outcomes for mastectomy. Over time, indications for TSSM broadened and our technique has evolved with a series of systematic improvements.

Methods

We reviewed all cases of TSSM with immediate breast reconstruction performed from 2005 to 2012. Patient comorbidities, treatment characteristics, postoperative complications, and outcomes were obtained prospectively and through medical chart review. Locoregional recurrences, distant recurrences, and patient survival were analyzed with Kaplan–Meier methods.

Results

During this 8-year period, 633 patients (981 cases) underwent TSSM with median follow-up time of 29 (interquartile range 14–54) months. Immediate breast reconstruction was performed with tissue expander placement (89 %), pedicle TRAM (5 %), free flap (5 %), permanent implant (0.3 %), or latissimus flap (0.2 %). The incidences of postoperative complications decreased significantly over time. In 2012, these were down to 3.5 % for superficial nipple necrosis, 1.0 % for complete nipple necrosis, 3.0 % for minor skin flap necrosis, 4.4 % for major skin flap necrosis, 13.3 % for infections requiring oral antibiotics, 9.9 % for infections requiring intravenous antibiotics, 3.4 % for infections requiring operative intervention, and 8.5 % for expander/implant. Overall 5-year cumulative incidences of recurrence were 3.0 % (locoregional) and 4.2 % (distant), and there were no recurrences in the NAC skin.

Conclusions

Systematic changes in our technique of TSSM and immediate breast reconstruction have decreased postoperative complications over time. Oncologic outcomes of locoregional and distal recurrences remain similar to skin-sparing mastectomy techniques.

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Disclosures

Hani Sbitany, MD is a member of the speaker’s bureau for LifeCell Corporation. He did not receive any compensation or financial support for this study. The remaining authors have no financial interest in any of the products or devices mentioned in this article.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Frederick Wang MD, Anne Warren Peled MD, Hani Sbitany MD & Robert D. Foster MD

  2. Carol Franc Buck Breast Care Center, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Allison Stover Fiscalini MPH, Michael Alvarado MD & Cheryl Ewing MD

  3. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    E. Shelley Hwang MD, MPH

  4. Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA

    Elisabeth Garwood MD

  5. Carol Franc Buck Breast Care Center, University of California, San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA

    Laura J. Esserman MD, MBA

Authors
  1. Frederick Wang MD
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  2. Anne Warren Peled MD
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  3. Elisabeth Garwood MD
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  4. Allison Stover Fiscalini MPH
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  5. Hani Sbitany MD
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  6. Robert D. Foster MD
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  7. Michael Alvarado MD
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  8. Cheryl Ewing MD
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  9. E. Shelley Hwang MD, MPH
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  10. Laura J. Esserman MD, MBA
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Corresponding author

Correspondence to Laura J. Esserman MD, MBA.

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Wang, F., Peled, A.W., Garwood, E. et al. Total Skin-Sparing Mastectomy and Immediate Breast Reconstruction: An Evolution of Technique and Assessment of Outcomes. Ann Surg Oncol 21, 3223–3230 (2014). https://doi.org/10.1245/s10434-014-3915-z

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  • DOI: https://doi.org/10.1245/s10434-014-3915-z

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