Breast Cancer Research and Treatment

, Volume 111, Issue 3, pp 391–403 | Cite as

Oncological and aesthetic considerations of skin-sparing mastectomy

  • Neill Patani
  • Kefah MokbelEmail author


Aim To review the oncological safety and aesthetic value of skin-sparing mastectomy (SSM) for invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS). Controversies including the impact of radiotherapy (RT) on immediate breast reconstruction (IBR), preservation of the nipple-areola complex (NAC) and the role of endoscopic mastectomy are also considered. Methods Literature review facilitated by Medline and PubMed databases. Results SSM is an oncologically safe technique in selected cases, including IBC <5 cm, multi-centric tumours, DCIS and prophylactic risk-reduction surgery. The high risk of local recurrence (LR) excludes inflammatory breast cancers and tumours with extensive involvement of the skin. SSM can facilitate IBR and is associated with an excellent aesthetic result. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMR) do not preclude SSM, however the cosmetic outcome may be affected. Nipple/areola preservation is possible for remote tumours, employing a frozen section protocol for the retro-areolar tissue. There is limited data available for endoscopic mastectomy and superiority over conventional SSM has not been established. Conclusion In appropriately selected cases SSM is oncologically adequate. There are several patient centred advantages over conventional mastectomy, including aesthetic outcome and the avoidance of multiple staged procedures. Despite widespread uptake into surgical practice, validation of these techniques from randomised controlled trials is lacking.


Aesthetic Breast cancer Ductal carcinoma in-situ Evidence Morbidity Mortality Nipple/Areola sparing mastectomy Oncological safety Radiotherapy Recurrence Skin-sparing Mastectomy 


  1. 1.
    Hidalgo DA, Borgen PJ, Petrek JA, Heerdt AH, Cody HS, Disa JJ (1998) Immediate reconstruction after complete skin-sparing mastectomy with autologous tissue. J Am Coll Surg 187(1):17–21PubMedCrossRefGoogle Scholar
  2. 2.
    Toth BA, Lappert P (1991) Modified skin incisions for mastectomy: the need for plastic surgical input in pre-operative planning. Plast Reconstr Surg 87:1048–1053PubMedCrossRefGoogle Scholar
  3. 3.
    Carlson GW (1996) Skin sparing mastectomy: anatomic and technical considerations. Am Surg 62:151–155PubMedGoogle Scholar
  4. 4.
    Uriburu JL, Vuoto HD, Cogorno L, Isetta JA, Candas G, Imach GC, Bernabo OL (2006) Local recurrence of breast cancer after skin-sparing mastectomy following core needle biopsy: case reports and review of the literature. Breast J 12(3):194–198PubMedCrossRefGoogle Scholar
  5. 5.
    Simmons RM, Adamovich TL (2003) Skin-sparing mastectomy. Surg Clin North Am 83:885–899PubMedCrossRefGoogle Scholar
  6. 6.
    Singletary SE, Kroll SS (1996) Skin-sparing mastectomy with immediate breast reconstruction. Adv Surg 30:39–52PubMedGoogle Scholar
  7. 7.
    Carlson GW, Moore B, Thornton JF, Elliott M, Bolitho G (2001) Breast cancer after augmentation mammaplasty: treatment by skin-sparing mastectomy and immediate reconstruction. Plast Reconstr Surg 107(3):687–692PubMedCrossRefGoogle Scholar
  8. 8.
    Sotheran WJ, Rainsbury RM (2004) Skin-sparing mastectomy in the UK- a review of current practice. Ann R Coll Surg Engl 86:82–86PubMedCrossRefGoogle Scholar
  9. 9.
    Bleicher RJ, Hansen NM, Giuliano AE (2003) Skin-sparing mastectomy. Specialty bias and worldwide lack of consensus. Cancer 98(11):2316–2321PubMedCrossRefGoogle Scholar
  10. 10.
    Gendy RK, Able JA, Rainsbury RM (2003) Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery. Br J Surg 90(4):433–439PubMedCrossRefGoogle Scholar
  11. 11.
    Shrotria S (2001) The peri-areolar incision—gateway to the breast!. Eur J Surg Oncol 27:601–603PubMedCrossRefGoogle Scholar
  12. 12.
    Hammond DC, Capraro PA, Ozolins EB, Arnold JF (2002) Use of a skin-sparing reduction pattern to create a combination skin-muscle flap pocket in immediate breast reconstruction. Plast Reconstr Surg 110:206–211PubMedCrossRefGoogle Scholar
  13. 13.
    Singletary SE, Robb GL (2003) Oncologic safety of skin-sparing mastectomy. Ann Surg Oncol 10:95–97PubMedCrossRefGoogle Scholar
  14. 14.
    Beer GM, Varga Z, Budi S, Seifert B, Meyer VE (2002) Incidence of the superficial fascia and its relevance in skin-sparing mastectomy. Cancer 94(6):1619–1625PubMedCrossRefGoogle Scholar
  15. 15.
    Carlson GW, Bostwick J 3rd, Styblo TN et al (1997) Skin sparing mastectomy, oncologic and reconstructive considerations. Ann Surg 225:570–575PubMedCrossRefGoogle Scholar
  16. 16.
    Stradling BL, Ahn M, Angelats J, Gabram SG (2001) Skin-sparing mastectomy with sentinel lymph node dissection: less is more. Arch Surg 136(9):1069–1075PubMedCrossRefGoogle Scholar
  17. 17.
    Meretoja TJ, Jahkola TA, Toivonen TS, Krogerus LA, Heikkila PS, von Smitten KA, Leidenius MH (2007) Sentinel node biopsy with intraoperative diagnosis in patients undergoing skin-sparing mastectomy and immediate breast reconstruction. Eur J Surg Oncol Apr 24; [Epub ahead of print]Google Scholar
  18. 18.
    Kuerer HM, Krishnamurthy S, Kronowitz SJ (2002) Important technical considerations for skin-sparing mastectomy with sentinel lymph node dissection. Arch Surg 137(6):747PubMedCrossRefGoogle Scholar
  19. 19.
    Schrenk P, Woelfl S, Bogner S, Moser F, Wayand W (2005) The use of sentinel node biopsy in breast cancer patients undergoing skin sparing mastectomy and immediate autologous reconstruction. Plast Reconstr Surg 116(5):1278–1286PubMedCrossRefGoogle Scholar
  20. 20.
    Friedlander LD, Sundin J, Bakshandeh N (1995) Endoscopy mastectomy and breast reconstruction: endoscopic breast surgery. Aesthetic Plast Surg 19(1):27–29PubMedCrossRefGoogle Scholar
  21. 21.
    Yamashita K, Shimizu K (2006) Endoscopic video-assisted breast surgery: procedures and short-term results. J Nippon Med Sch 73(4):193–202PubMedCrossRefGoogle Scholar
  22. 22.
    Lee EK, Kook SH, Park YL, Bae WG (2006) Endoscopy-assisted breast-conserving surgery for early breast cancer. World J Surg 30(6):957–964PubMedCrossRefGoogle Scholar
  23. 23.
    Tamaki Y, Tsukamoto F, Miyoshi Y, Tanji Y, Taguchi T, Noguchi S (2002) Overview: video-assisted breast surgery. Biomed Pharmacother 56(Suppl 1):187s–191sPubMedCrossRefGoogle Scholar
  24. 24.
    Nakajima H, Sakaguchi K, Mizuta N, Hachimine T, Ohe S, Sawai K (2002) Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother 56(Suppl 1):205s–208sPubMedCrossRefGoogle Scholar
  25. 25.
    Ho WS, Ying SY, Chan AC (2002) Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Surg Endosc 16(2):302–306PubMedCrossRefGoogle Scholar
  26. 26.
    Kitamura K, Ishida M, Inoue H, Kinoshita J, Hashizume M, Sugimachi K (2002) Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Surgery 131(1 Suppl):S324–S329PubMedCrossRefGoogle Scholar
  27. 27.
    Kroll SS (1997) Immediate breast reconstruction. A review. Ann Chir Gynaecol 86(1):5–12PubMedGoogle Scholar
  28. 28.
    Granzow JW, Levine JL, Chiu ES, Allen RJ (2006) Breast reconstruction using perforator flaps. J Surg Oncol 94(6):441–454PubMedCrossRefGoogle Scholar
  29. 29.
    Salgarello M, Seccia A, Eugenio F (2004) Immediate breast reconstruction with anatomical permanent expandable implants after skin-sparing mastectomy: aesthetic and technical refinements. Ann Plast Surg 52(4):358–364; discussion 365–366PubMedCrossRefGoogle Scholar
  30. 30.
    Salgarello M, Farallo E (2005) Immediate breast reconstruction with definitive anatomical implants after skin-sparing mastectomy. Br J Plast Surg 58(2):216–222PubMedCrossRefGoogle Scholar
  31. 31.
    Woerdeman LA, Hage JJ, Hofland MM, Rutgers EJ (2007) A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria. Plast Reconstr Surg 119(2):455–463PubMedCrossRefGoogle Scholar
  32. 32.
    Woerdeman LA, Hage JJ, Smeulders MJ, Rutgers EJ, van der Horst CM (2006) Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients. Plast Reconstr Surg 118(2):321–330; discussion 331–332PubMedCrossRefGoogle Scholar
  33. 33.
    Schneider WJ, Hill HL, Brown RG (1977) Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 30:277–281PubMedCrossRefGoogle Scholar
  34. 34.
    Pomel C, Missana MC, Atallah D, Lasser P (2003) Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol 29(2):127–131PubMedCrossRefGoogle Scholar
  35. 35.
    de la Torre JI, Fix RJ, Gardner PM, Vasconez LO (2001) Reconstruction with the latissimus dorsi flap after skin-sparing mastectomy. Ann Plast Surg 46(3):229–233CrossRefGoogle Scholar
  36. 36.
    Munhoz AM, Aldrighi C, Montag E, Arruda EG, Aldrighi JM, Filassi JR, Ferreira MC (2007) Periareolar skin-sparing mastectomy and latissimus dorsi flap with biodimensional expander implant reconstruction: surgical planning, outcome, and complications. Plast Reconstr Surg 119(6):1637–1649; discussion 1650–1652PubMedCrossRefGoogle Scholar
  37. 37.
    Holmstrom H (1979) The free abdominoplasty flap and its use in breast reconstruction. Scand J Plast Reconstr Surg 13: 423–427PubMedCrossRefGoogle Scholar
  38. 38.
    Blondeel PN (1999) One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 52(2):104–111PubMedCrossRefGoogle Scholar
  39. 39.
    Yano K, Hosokawa K, Nakai K, Kubo T, Hattori R, Taguchi T, Tamaki Y, Noguchi S (2003) Skin-sparing mastectomy and immediate reconstruction with a deep inferior epigastric perforator flap. Breast Cancer 10(3):275–280. Erratum in: Breast Cancer. 2003; 10(4):382–383PubMedGoogle Scholar
  40. 40.
    Munhoz AM, Arruda E, Montag E, Aldrighi C, Aldrighi JM, Gemperli R, Ferreira MC (2007) Immediate skin-sparing mastectomy reconstruction with deep inferior epigastric perforator (DIEP) flap. Technical aspects and outcome. Breast J 13(5):470–478PubMedCrossRefGoogle Scholar
  41. 41.
    Cocquyt VF, Blondeel PN, Depypere HT, Van De Sijpe KA, Daems KK, Monstrey SJ, Van Belle SJ (2003) Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg 56(5):462–470PubMedCrossRefGoogle Scholar
  42. 42.
    Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69(2):216–225PubMedGoogle Scholar
  43. 43.
    Arnez ZM, Bajec J, Bardsley AF, Scamp T, Webster MH (1991) Experience with 50 free TRAM flap breast reconstructions. Plast Reconstr Surg 87(3):470–478; discussion 479–482PubMedGoogle Scholar
  44. 44.
    Drucker-Zertuche M, Robles-Vidal C (2007) A 7 year experience with immediate breast reconstruction after skin sparing mastectomy for cancer. Eur J Surg Oncol 33(2):140–146PubMedCrossRefGoogle Scholar
  45. 45.
    Gherardini G, Thomas R, Basoccu G, Zaccheddu R, Fortunato L, Cortino P, Evans GR, Matarasso A, D’Aiuto M, D’Aiuto G (2001) Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy. Int Surg 86(4):246–251PubMedGoogle Scholar
  46. 46.
    Fujino T, Harasina T, Aoyagi F (1975) Reconstruction for aplasia of the breast and pectoral region by microvascular transfer of a free flap from the buttock. Plast Reconstr Surg 56:178–181PubMedGoogle Scholar
  47. 47.
    Allen RJ, Tucker C Jr (1995) Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 95:1207–1212PubMedCrossRefGoogle Scholar
  48. 48.
    Blondeel PN (1999) The sensate free superior gluteal artery perforator (S-GAP) flap: a valuable alternative in autologous breast reconstruction. Br J Plast Surg 52(3):185–193PubMedCrossRefGoogle Scholar
  49. 49.
    Guerra AB, Metzinger SE, Bidros RS, Gill PS, Dupin CL, Allen RJ (2004) Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases. Ann Plast Surg 52(2):118–125PubMedCrossRefGoogle Scholar
  50. 50.
    Wechselberger G, Schoeller T (2004) The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg 114(1):69–73PubMedCrossRefGoogle Scholar
  51. 51.
    Arnez ZM, Pogorelec D, Planinsek F, Ahcan U (2004) Breast reconstruction by the free transverse gracilis (TUG) flap. Br J Plast Surg 57(1):20–26PubMedCrossRefGoogle Scholar
  52. 52.
    Jimenez AG, St Germain P, Sirois M, Hatheway M, Lethbridge R (2002) Free omental flap for skin-sparing breast reconstruction harvested laparoscopically. Plast Reconstr Surg 110(2):545–551PubMedCrossRefGoogle Scholar
  53. 53.
    Barton FE Jr, English JM, Kingsley WB, Fietz M (1991) Glandular excision in total glandular mastectomy and modified radical mastectomy: a comparison. Plast Reconstr Surg 88(3):389–392; discussion 393–394PubMedCrossRefGoogle Scholar
  54. 54.
    Torresan RZ, Cabello dos Santos C, Brenelli H, Okamura H, Alvarenga M (2005) Residual glandular tissue after skin-sparing mastectomies. Breast J 11(5):374–375PubMedCrossRefGoogle Scholar
  55. 55.
    Torresan RZ, dos Santos CC, Okamura H, Alvarenga M (2005) Evaluation of residual glandular tissue after skin-sparing mastectomies. Ann Surg Oncol 12(12):1037–1044. Epub 2005 Oct 26PubMedCrossRefGoogle Scholar
  56. 56.
    Ho CM, Mak CK, Lau Y, Cheung WY, Chan MC, Hung WK (2003) Skin involvement in invasive breast carcinoma: safety of skin-sparing mastectomy. Ann Surg Oncol 10:102–107PubMedCrossRefGoogle Scholar
  57. 57.
    Newman LA, Kuerer HM, Hunt KK, Kroll SS, Ames FC, Ross MI, Feig BW, Singletary SE (1998) Presentation, treatment, and outcome of local recurrence afterskin-sparing mastectomy and immediate breast reconstruction. Ann Surg Oncol 5:620–626PubMedCrossRefGoogle Scholar
  58. 58.
    Simmons RM, Fish SK, Gayle L, La Trenta GS, Swistel A, Christos P, Osborne MP (1999) Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol 6:676–681PubMedCrossRefGoogle Scholar
  59. 59.
    Rivadeneira DE, Simmons RM, Fish SK, Gayle L, La Trenta GS, Swistel A, Osborne MP (2000) Skin-sparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence. Cancer J 6:331–335PubMedGoogle Scholar
  60. 60.
    Greenway RM, Schlossberg L, Dooley WC (2005) Fifteen-year series of skin-sparing mastectomy for stage 0 to 2 breast cancer. Am J Surg 190(6):918–922PubMedCrossRefGoogle Scholar
  61. 61.
    Meretoja TJ, Rasia S, von Smitten KA, Asko-Seljavaara SL, Kuokkanen HO, Jahkola TA (2007) Late results of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 94(10):1220–1225PubMedCrossRefGoogle Scholar
  62. 62.
    Meretoja TJ, von Smitten KA, Leidenius MH, Svarvar C, Heikkila PS, Jahkola TA (2007) Local recurrence of stage 1 and 2 breast cancer after skin-sparing mastectomy and immediate breast reconstruction in a 15-year series. Eur J Surg Oncol May 7; [Epub ahead of print]Google Scholar
  63. 63.
    Carlson GW, Styblo TM, Lyles RH, Jones G, Murray DR, Staley CA, Wood WC (2003) The use of skin sparing mastectomy in the treatment of breast cancer: The Emory experience. Surg Oncol 12:265–269PubMedCrossRefGoogle Scholar
  64. 64.
    Medina-Franco H, Vasconez LO, Fix RJ, Heslin MJ, Beenken SW, Bland KI, Urist MM (2002) Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg 235:814–819PubMedCrossRefGoogle Scholar
  65. 65.
    Spiegel AJ, Butler CE (2003) Recurrence following treatment of ductal carcinoma in situ with skin-sparing mastectomy and immediate breast reconstruction. Plast Reconstr Surg 111(2):706–711PubMedCrossRefGoogle Scholar
  66. 66.
    Kroll SS, Khoo A, Singletary SE, Ames FC, Wang BG, Reece GP, Miller MJ, Evans GR, Robb GL (1999) Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg 104:421–425PubMedCrossRefGoogle Scholar
  67. 67.
    Toth BA, Forley BG, Calabria R (1999) Retrospective study of the skin-sparing mastectomy in breast reconstruction. Plast Reconstr Surg 104:77–84PubMedCrossRefGoogle Scholar
  68. 68.
    Vaughan A, Dietz JR, Aft R, Gillanders WE, Eberlein TJ, Freer P, Margenthaler JA (2007) Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction. Am J Surg 194(4):438–443PubMedCrossRefGoogle Scholar
  69. 69.
    Downes KJ, Glatt BS, Kanchwala SK, Mick R, Fraker DL, Fox KR, Solin LJ, Bucky LP, Czerniecki BJ (2005) Skin-sparing mastectomy and immediate reconstruction is an acceptable treatment option for patients with high-risk breast carcinoma. Cancer 103:906–913PubMedCrossRefGoogle Scholar
  70. 70.
    Foster RD, Esserman LJ, Anthony JP, Hwang ES, Do H (2002) Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma. Ann Surg Oncol 9:462–466PubMedCrossRefGoogle Scholar
  71. 71.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241PubMedCrossRefGoogle Scholar
  72. 72.
    Allweis TM, Boisvert ME, Otero SE et al (2002) Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy. Am J Surg 183:218–221PubMedCrossRefGoogle Scholar
  73. 73.
    Langstein HN, Cheng MH, Singletary SE et al (2003) Breast cancer recurrence after immediate reconstruction: patterns and significances. Plast Reconstr Surg 111:712–720PubMedCrossRefGoogle Scholar
  74. 74.
    Carlson GW, Page A, Johnson E, Nicholson K, Styblo TM, Wood WC (2007) Local recurrence of ductal carcinoma in situ after skin-sparing mastectomy. J Am Coll Surg 204(5):1074–1078; discussion 1078–1080PubMedCrossRefGoogle Scholar
  75. 75.
    Mokbel K (2003) Towards optimal management of ductal carcinoma in situ of the breast. Eur J Surg Oncol 29:191–197PubMedCrossRefGoogle Scholar
  76. 76.
    Rubio IT, Mirza N, Sahin AA et al (2000) Role of specimen radiography in patients treated with skin-sparing mastectomy for ductal carcinoma in situ of the breast. Ann Surg Oncol 7:544–548PubMedCrossRefGoogle Scholar
  77. 77.
    Slavin SA, Schnitt SJ, Duda RB, Houlihan MJ, Koufman CN, Morris DJ, Troyan SL, Goldwyn RM (1998) Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 102:49–62PubMedCrossRefGoogle Scholar
  78. 78.
    Laronga C, Kemp B, Johnston D et al (1999) The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 6:609–613PubMedCrossRefGoogle Scholar
  79. 79.
    Vyas JJ, Chinoy RF, Vaidya JS (1998) Prediction of nipple and areola involvement in breast cancer. Eur J Surg Oncol 24:15–16PubMedCrossRefGoogle Scholar
  80. 80.
    Simmons RM, Brennan M, Christos P, King V, Osborne M (2002) Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol 9:165–168PubMedCrossRefGoogle Scholar
  81. 81.
    Cense HA, Rutgers EJ, Lopes Cardozo M, Van Lanschot JJ (2001) Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 27:521–526PubMedCrossRefGoogle Scholar
  82. 82.
    Gerber B, Krause A, Reimer T, Muller H, Kuchenmeister I, Makovitzky J, Kundt G, Friese K (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238:120–127PubMedCrossRefGoogle Scholar
  83. 83.
    Regolo L, Ballardini B, Gallarotti E, Scoccia E, Zanini V (2007) Nipple sparing mastectomy: an innovative skin incision for an alternative approach. Breast Sep 14; [Epub ahead of print]Google Scholar
  84. 84.
    Banerjee A, Gupta S, Bhattacharya N (2007) Preservation of nipple-areola complex in breast cancer—a clinicopathological assessment. J Plast Reconstr Aesthet Surg Sep 25; [Epub ahead of print]Google Scholar
  85. 85.
    Schecter AK, Freeman MB, Giri D, Sabo E, Weinzweig J (2006) Applicability of the nipple-areola complex-sparing mastectomy: a prediction model using mammography to estimate risk of nipple-areola complex involvement in breast cancer patients. Ann Plast Surg 56(5):498–504; discussion 504PubMedCrossRefGoogle Scholar
  86. 86.
    Vlajcic Z, Zic R, Stanec S, Lambasa S, Petrovecki M, Stanec Z (2005) Nipple-areola complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg 55(3):240–244PubMedCrossRefGoogle Scholar
  87. 87.
    Vlajcic Z, Zic R, Stanec S, Stanec Z (2005) Areola-sparing mastectomy with immediate breast reconstruction. Ann Plast Surg 54(5):581PubMedCrossRefGoogle Scholar
  88. 88.
    Petit JY, Veronesi U, Orecchia R, Luini A, Rey P, Intra M, Didier F, Martella S, Rietjens M, Garusi C, DeLorenzi F, Gatti G, Leon ME, Casadio C (2006) Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): a new type of mastectomy for breast cancer treatment. Breast Cancer Res Treat 96(1):47–51PubMedCrossRefGoogle Scholar
  89. 89.
    Petit JY, Veronesi U, Luini A, Orecchia R, Rey PC, Martella S, Didier F, De Lorenzi F, Rietjens M, Garusi C, Sonzogni A, Galimberti V, Leida E, Lazzari R, Giraldo A (2005) When mastectomy becomes inevitable: the nipple-sparing approach. Breast 14(6):527–531PubMedCrossRefGoogle Scholar
  90. 90.
    Bistoni G, Rulli A, Izzo L, Noya G, Alfano C, Barberini F (2006) Nipple-sparing mastectomy. Preliminary results. J Exp Clin Cancer Res 25(4):495–497PubMedGoogle Scholar
  91. 91.
    Verheyden CN (1998) Nipple-sparing total mastectomy of large breasts: the role of tissue expansion. Plast Reconstr Surg 101:1494PubMedCrossRefGoogle Scholar
  92. 92.
    Komorowski AL, Zanini V, Regolo L, Carolei A, Wysocki WM, Costa A (2006) Necrotic complications after nipple- and areola-sparing mastectomy. World J Surg 30(8):1410–1413PubMedCrossRefGoogle Scholar
  93. 93.
    Crowe JP Jr, Kim JA, Yetman R, Banbury J, Patrick RJ, Baynes D (2004) Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg 139:148–150PubMedCrossRefGoogle Scholar
  94. 94.
    Mustonen P, Lepisto J, Papp A et al (2004) The surgical and oncological safety of immediate breast reconstruction. Eur J Surg Oncol 30:817–823PubMedGoogle Scholar
  95. 95.
    Simmons RM, Hollenbeck ST, Latrenta GS (2003) Areola-sparing mastectomy with immediate breast reconstruction. Ann Plast Surg 51:547–551PubMedCrossRefGoogle Scholar
  96. 96.
    Simmons RM, Hollenbeck ST, Latrenta GS (2004) Two-year follow-up of areola-sparing mastectomy with immediate reconstruction. Am J Surg 188(4):403–406PubMedCrossRefGoogle Scholar
  97. 97.
    Recht A, Edge SB (2003) Evidence-based indications for postmastectomy irradiation. Surg Clin North Am 83:995–1013PubMedCrossRefGoogle Scholar
  98. 98.
    Hussien M, Salah B, Malyon A, Wieler-Mithoff EM (2004) The effect of radiotherapy on the use of immediate breast reconstruction. Eur J Surg Oncol 30:490–494PubMedCrossRefGoogle Scholar
  99. 99.
    Buchholz TA, Kronowitz SJ, Kuerer HM (2002) Immediate breast reconstruction after skin-sparing mastectomy for the treatment of advanced breast cancer: radiation oncology considerations. Ann Surg Oncol 9(8):820–821PubMedCrossRefGoogle Scholar
  100. 100.
    Kronowitz SJ, Robb GL (2004) Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 114:950–960PubMedCrossRefGoogle Scholar
  101. 101.
    Hunt KK, Baldwin BJ, Strom EA, Ames FC, McNeese MD, Kroll SS, Singletary SE (1997) Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction. Ann Surg Oncol 4:377–384PubMedCrossRefGoogle Scholar
  102. 102.
    Tran NV, Evans GR, Kroll SS, Baldwin BJ, Miller MJ, Reece GP, Robb GL (2000) Postoperative adjuvant irradiation: effects on tranverse rectus abdominis muscle flap breast reconstruction. Plast Reconstr Surg 106(2):313–317; discussion 318–320PubMedCrossRefGoogle Scholar
  103. 103.
    Evans GR, Schusterman MA, Kroll SS (1995) Reconstruction and the radiated breast: is there a role for implants? Plast Reconstr Surg 96:1111–1115PubMedCrossRefGoogle Scholar
  104. 104.
    Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K (2004) Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 113:877–881PubMedCrossRefGoogle Scholar
  105. 105.
    Kronowitz SJ, Hunt KK, Kuerer HM, Babiera G, McNeese MD, Buchholz TA, Strom EA, Robb GL (2004) Delayed-immediate breast reconstruction. Plast Reconstr Surg 113(6):1617–1628PubMedCrossRefGoogle Scholar
  106. 106.
    Hultman CS, Daiza S (2003) Skin-sparing mastectomy flap complications after breast reconstruction: review of incidence, management, and outcome. Ann Plast Surg 50:249–255PubMedCrossRefGoogle Scholar
  107. 107.
    Benediktsson K, Perbeck L (1999) The influence of radiotherapy on skin circulation of the breast after subcutaneous mastectomy and immediate reconstruction. Br J Plast Surg 52:360–364PubMedCrossRefGoogle Scholar
  108. 108.
    Chang EI, Ly DP, Wey PD (2007) Comparison of aesthetic breast reconstruction after skin-sparing or conventional mastectomy in patients receiving preoperative radiation therapy. Ann Plast Surg 59(1):78–81PubMedCrossRefGoogle Scholar
  109. 109.
    Disa JJ, Cordeiro PG, Heerdt AH, Petrek JA, Borgen PJ, Hidalgo DA (2003) Skin-sparing mastectomy and immediate autologous tissue reconstruction after whole-breast irradiation. Plast Reconstr Surg 111:118–124PubMedCrossRefGoogle Scholar
  110. 110.
    Mokbel R, Mokbel K (2006) Skin-sparing mastectomy and radiotherapy: an update. Int Semin Surg Oncol 3:35PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2007

Authors and Affiliations

  1. 1.London Breast InstituteThe Princess Grace HospitalLondonUK
  2. 2.St. George’s University of LondonLondonUK

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