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Expanding the Indications for Total Skin-Sparing Mastectomy: Is It Safe for Patients with Locally Advanced Disease?

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

Abstract

Background

Indications for total skin-sparing mastectomy (TSSM) continue to expand. Although initially used only for early-stage breast cancer, TSSM currently is offered in many centers to patients with locally advanced disease. However, despite this practice change, limited data on oncologic outcomes in this population have been reported.

Methods

A retrospective review of a prospectively collected database of all patients undergoing TSSM and immediate reconstruction from 2005 to 2013 was performed. The outcomes for patients with stage 2b and stage 3 cancer were included in the analysis. The primary outcomes included the development of locoregional or distant recurrences.

Results

Of 753 patients undergoing TSSM, 139 (18 %) presented with locally advanced disease. Of these 139 patients, 25 (18 %) had stage 2b disease, and 114 (82 %) had stage 3 disease. Most of the patients (97 %) received chemotherapy (77 % neoadjuvant, 20 % adjuvant), whereas 3 % received adjuvant hormonal therapy alone. Of the neoadjuvant patients, 13 (12 %) had a pathologic complete response (pCR) to treatment. During a mean follow-up period of 41 months (range 4–111 months), seven patients (5 %) had a local recurrence, 21 patients (15.1 %) had a distant recurrence, and three patients (2.2 %) had simultaneous local and distant recurrences. None of the local recurrences occurred in the preserved nipple–areolar complex skin.

Conclusions

Patients with locally advanced breast cancer are most at risk for distant rather than local recurrence, even after TSSM. When used in conjunction with appropriate multimodal therapy, TSSM is not associated with an increased risk for local recurrence in this population, even in the setting of low pCR rates.

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References

  1. Crowe JP, Kim JA, Yetman R, et al. Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg. 2004;139:148–50.

    Article  PubMed  Google Scholar 

  2. Vlajcic Z, Zic R, Stanec S, et al. Nipple–areola complex preservation: predictive factors of neoplastic nipple–areola complex invasion. Ann Plast Surg. 2005;55:240–4.

    Article  PubMed  CAS  Google Scholar 

  3. Spear SL, Hannan CM, Willey SC, Cocilovo C. Nipple-sparing mastectomy. Plast Reconstr Surg. 2009;123:1665–73.

    Article  PubMed  CAS  Google Scholar 

  4. Wijayanayagam A, Kumar AS, Foster RD, Esserman LJ. Optimizing the total skin-sparing mastectomy. Arch Surg. 2008;143:38–45.

    Article  PubMed  Google Scholar 

  5. de Alcantara Filho P, Capko D, Barry JM, et al. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18:3117–22.

    Article  Google Scholar 

  6. Kneubil MC, Lohsiriwat V, Curigliano G, et al. Risk of locoregional recurrence in patients with false-negative frozen section or close margins of retroareolar specimen in nipple-sparing mastectomy. Ann Surg Oncol. 2012;19:4117–23.

    Article  PubMed  Google Scholar 

  7. Boneti C, Yuen J, Santiago C, et al. Oncologic safety of nipple skin-sparing or total skin-sparing mastectomies with immediate reconstruction. J Am Coll Surg. 2011;212:686–93.

    Article  PubMed  Google Scholar 

  8. Wang F, Warren Peled A, Garwood E, et al. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes. Ann Surg Oncol. 2014;21:3223–30.

    Article  PubMed  Google Scholar 

  9. Burdge EC, Yuen J, Hardee M, et al. Nipple skin-sparing mastectomy is feasible for advanced disease. Ann Surg Oncol. 2013;20:3294–302.

    Article  PubMed  Google Scholar 

  10. Fortunato L, Loreti A, Andrich R, et al. When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications? J Surg Oncol. 2013;108:207–12.

    Article  PubMed  Google Scholar 

  11. Poruk KE, Ying J, Chidester JR, et al. Breast cancer recurrence after nipple-sparing mastectomy: one institution’s experience. Am J Surg. 2015;209:212–7.

    Article  PubMed  Google Scholar 

  12. Spear SL, Shuck J, Hannan L, Albino F, Patel K. Evaluating long-term outcomes following nipple-sparing mastectomy and reconstruction in the irradiated breast. Plast Reconstr Surg. 2014;133:605e–14e.

    Article  PubMed  CAS  Google Scholar 

  13. Piper M, Warren Peled A, Foster RD, Moore DH, Esserman LJ. Total skin-sparing mastectomy: a systematic review of oncologic outcomes and postoperative complications. Ann Plast Surg. 2013;70:435–7.

    Article  PubMed  CAS  Google Scholar 

  14. Colwell AS, Tessler O, Lin AM, et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg. 2014;133:496–506.

    Article  PubMed  CAS  Google Scholar 

  15. Warren Peled A, Foster RD, Ligh C, Esserman LJ, Fowble B, Sbitany H. Impact of total skin-sparing mastectomy incision type on reconstructive complications following radiation therapy. Plast Reconstr Surg. 2014;134:169–75.

  16. Warren Peled A, Foster RD, Esserman LJ, Hwang ES, Fowble B. Increasing the time to expander-implant exchange after postmastectomy radiation therapy reduces expander-implant failure. Plast Recon Surg. 2012;130:503–9.

    Article  CAS  Google Scholar 

  17. Warren Peled A, Sbitany H, Foster RD, Esserman LJ. Oncoplastic mammoplasty as a strategy for reducing reconstructive complications associated with postmastectomy radiation therapy. Breast J. 2014;20:302–7.

  18. Warren Peled A, Wang F, Stover AC, et al. Selective use of postmastectomy radiation therapy in the neoadjuvant setting. San Antonio Breast Cancer Symposium, San Antonio, TX, Dec 2012.

  19. Fowble BL, Einck JP, Kim DN, et al. Role of postmastectomy radiation after neoadjuvant chemotherapy in stage II–III breast cancer. Int J Radiat Oncol Biol Phys. 2012;83:494–503.

    Article  PubMed  Google Scholar 

  20. Cho JH, Park JM, Park HS, et al. Oncologic safety of breast-conserving surgery compared to mastectomy in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer. J Surg Oncol. 2013;108:531–6.

    Article  PubMed  Google Scholar 

  21. Shim SJ, Park W, Huh SJ, et al. The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II–III breast cancer patients with pN0: a multicenter, retrospective study (KROG 12-05). Int J Radiat Oncol Biol Phys. 2014;88:65–72.

    Article  PubMed  Google Scholar 

  22. Cureton EL, Yau C, Alvarado MD, et al. Local recurrence rates are low in high-risk neoadjuvant breast cancer in the I-SPY 1 Trial (CALGB 150007/150012; ACRIN 6657). Ann Surg Oncol. 2014;21:2889–96.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ataseven B, Lederer B, Blohmer JU, et al. Impact of multifocal or multicentric disease on surgery and locoregional, distant, and overall survival of 6134 breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol. 2014;22:1118–27.

    Article  PubMed  Google Scholar 

  24. Spanheimer PM, Carr JC, Thomas A, et al. The response to neoadjuvant chemotherapy predicts clinical outcome and increases breast conservation in advanced breast cancer. Am J Surg. 2013;206:2–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Esserman LJ, Berry DA, DeMichele A, et al. Pathologic complete response predicts recurrence-free survival more effectively by cancer subset: results from the I-SPY 1 TRIAL—CALGB 150007/150012, ACRIN 6657. J Clin Oncol. 2012;30:3242–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Boughey JC, McCall LM, Ballman KV, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014;260:608–14.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lim W, Ko BS, Kim HJ, et al. Oncological safety of skin sparing mastectomy followed by immediate reconstruction for locally advanced breast cancer. J Surg Oncol. 2010;102:39–42.

    Article  PubMed  Google Scholar 

  28. Aurilio G, Bagnardi V, Graffeo R, et al. Does immediate breast reconstruction after mastectomy and neoadjuvant chemotherapy influence the outcome of patients with non-endocrine responsive breast cancer? Anticancer Res. 2014;34:6677–83.

    PubMed  Google Scholar 

  29. Meyers MO, Klauber-DeMore N, Ollila DW, et al. Impact of breast cancer molecular subtypes on locoregional recurrence in patients treated with neoadjuvant chemotherapy for locally advanced breast cancer. Ann Surg Oncol. 2011;18:2851–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

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

    Anne Warren Peled MD, Michael Alvarado MD, Cheryl A. Ewing MD & Laura J. Esserman MD, MBA

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

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

Authors
  1. Anne Warren Peled MD
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  2. Frederick Wang MD
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  3. Robert D. Foster MD
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  4. Michael Alvarado MD
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  5. Cheryl A. Ewing MD
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  6. Hani Sbitany MD
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  7. Laura J. Esserman MD, MBA
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Corresponding author

Correspondence to Laura J. Esserman MD, MBA.

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Peled, A.W., Wang, F., Foster, R.D. et al. Expanding the Indications for Total Skin-Sparing Mastectomy: Is It Safe for Patients with Locally Advanced Disease?. Ann Surg Oncol 23, 87–91 (2016). https://doi.org/10.1245/s10434-015-4734-6

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  • DOI: https://doi.org/10.1245/s10434-015-4734-6

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