Annals of Surgical Oncology

, Volume 10, Issue 2, pp 102–107 | Cite as

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

  • Chiu M. Ho
  • Colin K. L. Mak
  • Yvonne Lau
  • Wing Y. Cheung
  • Miranda C. M. Chan
  • Wai K. Hung
Original Articles


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 


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  1. 1.
    Toth B, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 1991; 87: 1048–53.PubMedGoogle Scholar
  2. 2.
    Kroll SS, Ames F, Singletary SE, Schusterman MA. The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast. Surg Gynecol Obstet 1991; 172: 17–20.PubMedGoogle Scholar
  3. 3.
    Carlson GW, Bostwick J, Styblo TM, et al. Skin-sparing mastectomy: oncologic and reconstructive considerations. Ann Surg 1997; 4: 193–7.Google Scholar
  4. 4.
    Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 1998; 102: 49–62.PubMedGoogle Scholar
  5. 5.
    Newman LA, Kuerer HM, Hunt KK, et al. Presentation, treatment and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction. Ann Surg Oncol 1998; 5: 620–6.PubMedGoogle Scholar
  6. 6.
    Kroll SS, Khoo A, Singletary E, et al. Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg 1999; 104: 421–5.PubMedGoogle Scholar
  7. 7.
    Simmons RM, Fish SK, Gayke L, et al. Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol 1999; 6: 676–81.PubMedGoogle Scholar
  8. 8.
    Kissin MW, Kark AE. Nipple preservation during mastectomy. Br J Surg 1987; 74: 58–61.PubMedGoogle Scholar
  9. 9.
    Laronga C, Kemp B, Johnston D, Robb GL, Singletary SE. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 1999; 6: 609–13.PubMedGoogle Scholar
  10. 10.
    Fisher ER, Gregorio RM, Fisher B, Redmond C, Vellios F, Sommers SC. The pathology of invasive breast cancer. Cancer 1975; 36: 1–85.PubMedGoogle Scholar
  11. 11.
    Wertheim U, Ozzello L. Neoplastic involvement of nipple and skin flap in carcinoma of the breast. Am J Surg Pathol 1980; 4: 543–9.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Chiu M. Ho
    • 1
    • 4
  • Colin K. L. Mak
    • 3
  • Yvonne Lau
    • 2
  • Wing Y. Cheung
    • 1
  • Miranda C. M. Chan
    • 2
  • Wai K. Hung
    • 2
  1. 1.Department of Surgery, Division of Plastic Surgery (CMH, WYC)Kwong Wah HospitalHong Kong SARChina
  2. 2.Department of Breast Center (YL, MCMC, WKH)Kwong Wah HospitalHong Kong SARChina
  3. 3.Department of Pathology (CKLM)Kwong Wah HospitalHong Kong SARChina
  4. 4.Division of Plastic Surgery, Department of SurgeryKwong Wah HospitalHong Kong SARChina

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