Abstract
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.
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References
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):17–21
Toth BA, Lappert P (1991) Modified skin incisions for mastectomy: the need for plastic surgical input in pre-operative planning. Plast Reconstr Surg 87:1048–1053
Carlson GW (1996) Skin sparing mastectomy: anatomic and technical considerations. Am Surg 62:151–155
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):194–198
Simmons RM, Adamovich TL (2003) Skin-sparing mastectomy. Surg Clin North Am 83:885–899
Singletary SE, Kroll SS (1996) Skin-sparing mastectomy with immediate breast reconstruction. Adv Surg 30:39–52
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):687–692
Sotheran WJ, Rainsbury RM (2004) Skin-sparing mastectomy in the UK- a review of current practice. Ann R Coll Surg Engl 86:82–86
Bleicher RJ, Hansen NM, Giuliano AE (2003) Skin-sparing mastectomy. Specialty bias and worldwide lack of consensus. Cancer 98(11):2316–2321
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):433–439
Shrotria S (2001) The peri-areolar incision—gateway to the breast!. Eur J Surg Oncol 27:601–603
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 110:206–211
Singletary SE, Robb GL (2003) Oncologic safety of skin-sparing mastectomy. Ann Surg Oncol 10:95–97
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):1619–1625
Carlson GW, Bostwick J 3rd, Styblo TN et al (1997) Skin sparing mastectomy, oncologic and reconstructive considerations. Ann Surg 225:570–575
Stradling BL, Ahn M, Angelats J, Gabram SG (2001) Skin-sparing mastectomy with sentinel lymph node dissection: less is more. Arch Surg 136(9):1069–1075
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]
Kuerer HM, Krishnamurthy S, Kronowitz SJ (2002) Important technical considerations for skin-sparing mastectomy with sentinel lymph node dissection. Arch Surg 137(6):747
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):1278–1286
Friedlander LD, Sundin J, Bakshandeh N (1995) Endoscopy mastectomy and breast reconstruction: endoscopic breast surgery. Aesthetic Plast Surg 19(1):27–29
Yamashita K, Shimizu K (2006) Endoscopic video-assisted breast surgery: procedures and short-term results. J Nippon Med Sch 73(4):193–202
Lee EK, Kook SH, Park YL, Bae WG (2006) Endoscopy-assisted breast-conserving surgery for early breast cancer. World J Surg 30(6):957–964
Tamaki Y, Tsukamoto F, Miyoshi Y, Tanji Y, Taguchi T, Noguchi S (2002) Overview: video-assisted breast surgery. Biomed Pharmacother 56(Suppl 1):187s–191s
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–208s
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):302–306
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–S329
Kroll SS (1997) Immediate breast reconstruction. A review. Ann Chir Gynaecol 86(1):5–12
Granzow JW, Levine JL, Chiu ES, Allen RJ (2006) Breast reconstruction using perforator flaps. J Surg Oncol 94(6):441–454
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 365–366
Salgarello M, Farallo E (2005) Immediate breast reconstruction with definitive anatomical implants after skin-sparing mastectomy. Br J Plast Surg 58(2):216–222
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):455–463
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 331–332
Schneider WJ, Hill HL, Brown RG (1977) Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 30:277–281
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):127–131
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):229–233
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 1650–1652
Holmstrom H (1979) The free abdominoplasty flap and its use in breast reconstruction. Scand J Plast Reconstr Surg 13: 423–427
Blondeel PN (1999) One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 52(2):104–111
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):382–383
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):470–478
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):462–470
Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69(2):216–225
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 479–482
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):140–146
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):246–251
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 56:178–181
Allen RJ, Tucker C Jr (1995) Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 95:1207–1212
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):185–193
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):118–125
Wechselberger G, Schoeller T (2004) The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg 114(1):69–73
Arnez ZM, Pogorelec D, Planinsek F, Ahcan U (2004) Breast reconstruction by the free transverse gracilis (TUG) flap. Br J Plast Surg 57(1):20–26
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):545–551
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 393–394
Torresan RZ, Cabello dos Santos C, Brenelli H, Okamura H, Alvarenga M (2005) Residual glandular tissue after skin-sparing mastectomies. Breast J 11(5):374–375
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 26
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 10:102–107
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 5:620–626
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 6:676–681
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 6:331–335
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):918–922
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):1220–1225
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]
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 12:265–269
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 235:814–819
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):706–711
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 104:421–425
Toth BA, Forley BG, Calabria R (1999) Retrospective study of the skin-sparing mastectomy in breast reconstruction. Plast Reconstr Surg 104:77–84
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):438–443
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 103:906–913
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 9:462–466
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 347:1233–1241
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 183:218–221
Langstein HN, Cheng MH, Singletary SE et al (2003) Breast cancer recurrence after immediate reconstruction: patterns and significances. Plast Reconstr Surg 111:712–720
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 1078–1080
Mokbel K (2003) Towards optimal management of ductal carcinoma in situ of the breast. Eur J Surg Oncol 29:191–197
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 7:544–548
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 102:49–62
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 6:609–613
Vyas JJ, Chinoy RF, Vaidya JS (1998) Prediction of nipple and areola involvement in breast cancer. Eur J Surg Oncol 24:15–16
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 9:165–168
Cense HA, Rutgers EJ, Lopes Cardozo M, Van Lanschot JJ (2001) Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 27:521–526
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 238:120–127
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]
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]
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 504
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):240–244
Vlajcic Z, Zic R, Stanec S, Stanec Z (2005) Areola-sparing mastectomy with immediate breast reconstruction. Ann Plast Surg 54(5):581
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):47–51
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):527–531
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):495–497
Verheyden CN (1998) Nipple-sparing total mastectomy of large breasts: the role of tissue expansion. Plast Reconstr Surg 101:1494
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):1410–1413
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 139:148–150
Mustonen P, Lepisto J, Papp A et al (2004) The surgical and oncological safety of immediate breast reconstruction. Eur J Surg Oncol 30:817–823
Simmons RM, Hollenbeck ST, Latrenta GS (2003) Areola-sparing mastectomy with immediate breast reconstruction. Ann Plast Surg 51:547–551
Simmons RM, Hollenbeck ST, Latrenta GS (2004) Two-year follow-up of areola-sparing mastectomy with immediate reconstruction. Am J Surg 188(4):403–406
Recht A, Edge SB (2003) Evidence-based indications for postmastectomy irradiation. Surg Clin North Am 83:995–1013
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 30:490–494
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):820–821
Kronowitz SJ, Robb GL (2004) Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 114:950–960
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 4:377–384
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 318–320
Evans GR, Schusterman MA, Kroll SS (1995) Reconstruction and the radiated breast: is there a role for implants? Plast Reconstr Surg 96:1111–1115
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 113:877–881
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):1617–1628
Hultman CS, Daiza S (2003) Skin-sparing mastectomy flap complications after breast reconstruction: review of incidence, management, and outcome. Ann Plast Surg 50:249–255
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 52:360–364
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):78–81
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 111:118–124
Mokbel R, Mokbel K (2006) Skin-sparing mastectomy and radiotherapy: an update. Int Semin Surg Oncol 3:35
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Patani, N., Mokbel, K. Oncological and aesthetic considerations of skin-sparing mastectomy. Breast Cancer Res Treat 111, 391–403 (2008). https://doi.org/10.1007/s10549-007-9801-7
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DOI: https://doi.org/10.1007/s10549-007-9801-7