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

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

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

ClinicalTrials.gov Identifier NCT03470909.

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Acknowledgment

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.

Funding

Funding

Estée Lauder Breast Cancer Research Foundation.

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Authors and Affiliations

  1. Clinical Trial Unit, Brust-Zentrum, Zurich, Switzerland

    Bärbel Papassotiropoulos MD

  2. Department of Breast Surgery, Brust-Zentrum, Zurich, Switzerland

    Uwe Güth MD, Federica Chiesa MD, Christoph Rageth MD, Esther Amann MD, Astrid Baege MD, Constanze Elfgen MD & Christoph Tausch MD

  3. Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland

    Zsuzsanna Varga MD, Linda Moskovszky MD & Katharina Endhardt MD

  4. Pathologie Institut Enge, Zurich, Switzerland

    Regina Masser MD & Marianne Tinguely MD

  5. Department of Plastic Surgery, Brust-Zentrum, Zurich, Switzerland

    Jian Farhadi MD & Alessia Lardi MD

  6. Radiology, Brust-Zentrum, Zurich, Switzerland

    Florian Dammann MD

  7. Pathology, Lucerne Cantonal Hospital, Lucerne, Switzerland

    Joachim Diebold MD

  8. Statistician Unit, Swiss Group for Clinical Cancer Research, Bern, Switzerland

    Qiyu Li MSc

  9. Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland

    Peter Dubsky MD

  10. Department of Surgery, Medical University of Vienna, Vienna, Austria

    Peter Dubsky MD

Authors
  1. Bärbel Papassotiropoulos MD
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  2. Uwe Güth MD
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  3. Federica Chiesa MD
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  18. Peter Dubsky MD
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  19. Christoph Tausch MD
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Correspondence to Bärbel Papassotiropoulos MD.

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Papassotiropoulos, B., Güth, U., Chiesa, F. et al. Prospective Evaluation of Residual Breast Tissue After Skin- or Nipple-Sparing Mastectomy: Results of the SKINI-Trial. Ann Surg Oncol 26, 1254–1262 (2019). https://doi.org/10.1245/s10434-019-07259-1

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  • DOI: https://doi.org/10.1245/s10434-019-07259-1

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