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Annals of Surgical Oncology

, Volume 21, Issue 10, pp 3223–3230 | Cite as

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

  • Frederick Wang
  • Anne Warren Peled
  • Elisabeth Garwood
  • Allison Stover Fiscalini
  • Hani Sbitany
  • Robert D. Foster
  • Michael Alvarado
  • Cheryl Ewing
  • E. Shelley Hwang
  • Laura J. Esserman
Breast Oncology

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.

Keywords

Breast Reconstruction Distant Recurrence Locoregional Recurrence Nipple Acellular Dermal Matrix 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

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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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Frederick Wang
    • 1
  • Anne Warren Peled
    • 1
  • Elisabeth Garwood
    • 4
  • Allison Stover Fiscalini
    • 2
  • Hani Sbitany
    • 1
  • Robert D. Foster
    • 1
  • Michael Alvarado
    • 2
  • Cheryl Ewing
    • 2
  • E. Shelley Hwang
    • 3
  • Laura J. Esserman
    • 5
  1. 1.Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Carol Franc Buck Breast Care Center, Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of SurgeryDuke University Medical CenterDurhamUSA
  4. 4.Department of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Carol Franc Buck Breast Care CenterUniversity of California, San FranciscoSan FranciscoUSA

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