Annals of Surgical Oncology

, Volume 26, Issue 5, pp 1254–1262 | Cite as

Prospective Evaluation of Residual Breast Tissue After Skin- or Nipple-Sparing Mastectomy: Results of the SKINI-Trial

  • Bärbel PapassotiropoulosEmail author
  • Uwe Güth
  • Federica Chiesa
  • Christoph Rageth
  • Esther Amann
  • Astrid Baege
  • Constanze Elfgen
  • Zsuzsanna Varga
  • Linda Moskovszky
  • Katharina Endhardt
  • Regina Masser
  • Marianne Tinguely
  • Jian Farhadi
  • Alessia Lardi
  • Florian Dammann
  • Joachim Diebold
  • Qiyu Li
  • Peter Dubsky
  • Christoph Tausch
Breast Oncology


This study was designed to investigate the presence of residual breast tissue (RBT) after skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) and to analyse patient- and therapy-related factors associated with RBT. Skin-sparing mastectomy and NSM are increasingly used surgical procedures. Prospective data on the completeness of breast tissue resection is lacking. However, such data are crucial for assessing oncologic safety of risk-reducing and curative mastectomies.


Between April 2016 and August 2017, 99 SSM and 61 NSM were performed according to the SKINI-trial protocol, under either curative (n = 109) or risk-reducing (n = 51) indication. After breast removal, biopsies from the skin envelope (10 biopsies per SSM, 14 biopsies per NSM) were taken in predefined radial localizations and assessed histologically for the presence of RBT and of residual disease.


Residual breast tissue was detected in 82 (51.3%) mastectomies. The median RBT percentage per breast was 7.1%. Of all factors considered, only type of surgery (40.4% for SSM vs. 68.9% for NSM; P < 0.001) and surgeon (P < 0.001) were significantly associated with RBT. None of the remaining factors, e.g., skin flap necrosis, was associated significantly with RBT. Residual disease was detected in three biopsies.


Residual breast tissue is commonly observed after SSM and NSM. In contrast, invasive or in situ carcinomas are rarely found in the skin envelope. Radicality of mastectomy in this trial is not associated with increased incidence of skin flap necrosis. Identifier NCT03470909.



The authors thank the participating patients who made this study possible. The authors thank the surgical staff of the involved hospitals for their support and patience. The authors also thank A. Beccarelli, M. Brück, and M. von Wantoch for patient data registration and administration and A. Papassotiropoulos for statistical and scientific input. The study was supported by the Estée Lauder Breast Cancer Research Foundation.


Estée Lauder Breast Cancer Research Foundation.


The authors declare no conflict of interest.

Supplementary material

10434_2019_7259_MOESM1_ESM.pdf (89 kb)
Supplementary material 1 (PDF 89 kb)


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Bärbel Papassotiropoulos
    • 1
    Email author
  • Uwe Güth
    • 2
  • Federica Chiesa
    • 2
  • Christoph Rageth
    • 2
  • Esther Amann
    • 2
  • Astrid Baege
    • 2
  • Constanze Elfgen
    • 2
  • Zsuzsanna Varga
    • 3
  • Linda Moskovszky
    • 3
  • Katharina Endhardt
    • 3
  • Regina Masser
    • 4
  • Marianne Tinguely
    • 4
  • Jian Farhadi
    • 5
  • Alessia Lardi
    • 5
  • Florian Dammann
    • 6
  • Joachim Diebold
    • 7
  • Qiyu Li
    • 8
  • Peter Dubsky
    • 9
    • 10
  • Christoph Tausch
    • 2
  1. 1.Clinical Trial UnitBrust-ZentrumZurichSwitzerland
  2. 2.Department of Breast SurgeryBrust-ZentrumZurichSwitzerland
  3. 3.Institute of Pathology and Molecular PathologyUniversity Hospital ZurichZurichSwitzerland
  4. 4.Pathologie Institut EngeZurichSwitzerland
  5. 5.Department of Plastic SurgeryBrust-ZentrumZurichSwitzerland
  6. 6.RadiologyBrust-ZentrumZurichSwitzerland
  7. 7.PathologyLucerne Cantonal HospitalLucerneSwitzerland
  8. 8.Statistician UnitSwiss Group for Clinical Cancer ResearchBernSwitzerland
  9. 9.Breast CenterHirslanden Clinic St. AnnaLucerneSwitzerland
  10. 10.Department of SurgeryMedical University of ViennaViennaAustria

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