Review
Skin-sparing mastectomy

https://doi.org/10.1016/j.amjsurg.2004.02.004Get rights and content

Abstract

Background

Skin-sparing mastectomy represents a new surgical approach that allows a mastectomy while preserving the natural skin envelope of the breast. It facilitates immediate breast reconstruction using an implant or myocutaneous flap, resulting in excellent cosmesis.

Data sources

A PubMed database literature search was performed.

Conclusions

Skin-sparing mastectomy is an oncologically safe technique in selected cases; T1/T2, multicentric tumors, ductal carcinoma in situ, and prophylactic mastectomies are particularly suited to this technique. Further research is required to confirm oncologic safety in T3 tumors. In selected cases, the nipple-areola complex can be preserved. A modification of skin-sparing mastectomy includes the removal of the nipple while preserving the areola. The balance of evidence suggests that skin-sparing mastectomy does not increase the risk of locoregional recurrence. Furthermore, it does not delay adjuvant therapies. Contraindications to skin-sparing mastectomy approaches include inflammatory breast cancer and extensive skin involvement by tumor. Preoperative and postoperative radiotherapy are not a contraindication to skin-sparing mastectomy.

Section snippets

Oncologic safety

The aim of mastectomy for breast cancer and for cancer prophylaxis is to remove as much breast tissue as possible. The only difference between SSM and conventional non–skin-sparing (NSSM) should be that the skin envelope is preserved in the latter; the same amount of breast tissue should be removed. Skin-sparing mastectomy also entails excision of the biopsy scar, skin obviously involved by tumor or overlying a superficial tumor in order to reduce the risk of local recurrence [2]. If there is

Ductal carcinoma in situ and skin-sparing mastectomy

Total mastectomy (NSSM) for DCIS achieves cure rates approaching 98% (local recurrence rate of 1.4% and breast cancer–specific mortality of 0.59%) [23]. Additionally, no adjuvant therapy is required after such treatment. Therefore, SSM and immediate breast reconstruction would seem an ideal option for patients necessitating or requesting mastectomy and reconstruction for DCIS, provided clear margins are achieved. This was examined in detail by Rubio et al [24]. In that study 95 patients

Preservation of the nipple-areola complex

The conventional SSM described earlier involves removal of the nipple-areola complex. This has a significant impact on the overall cosmetic effect of the breast reconstruction. The nipple-areola complex is removed because of the belief that the nipple-areola complex and its adjacent ducts may also harbour tumor cells that have spread distally along the ducts from the primary tumor. This belief was based on older studies that had demonstrated occult tumor in the region of the nipple-areola

Radiotherapy and skin-sparing mastectomy

The majority of women undergoing mastectomy do not require postoperative radiotherapy. However, patients with at least four positive regional lymph nodes or large (>5 cm) tumors are offered such treatment because it reduces the incidence of locoregional recurrence and improves survival [31]. Consequently, radiotherapy is indicated in some women who have undergone SSM and immediate breast reconstruction. Postmastectomy radiotherapy is, however, associated with local complications, thus causing

References (36)

  • G.W. Carlson et al.

    Skin sparing mastectomy, oncologic and reconstructive considerations

    Ann Surg

    (1998)
  • G.W. Carlson

    Skin sparing mastectomyanatomic and technical considerations

    Am Surg

    (1996)
  • D.A. Hidalgo

    Aesthetic refinement in breast reconstructioncomplete skin-sparing mastectomy with autogenous tissue transfer

    Plast Reconstr Surg

    (1998)
  • B.A. Toth et al.

    Retrospective study of the skin-sparing mastectomy in breast reconstruction

    Plast Reconstr Surg

    (1999)
  • D.C. Hammond et al.

    Use of a skin-sparing reduction pattern to create a combination skin-muscle flap pocket in immediate breast reconstruction

    Plast Reconstr Surg

    (2002)
  • C.M. Ho et al.

    Skin involvement in invasive breast carcinomasafety of skin-sparing mastectomy

    Ann Surg Oncol

    (2003)
  • G.W. Carlson et al.

    Local recurrence after skin-sparing mastectomytumor biology or surgical conservatism?

    Ann Surg Oncol

    (2003)
  • H. Medina-Franco et al.

    Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer

    Ann Surg

    (2002)
  • Cited by (106)

    • Oncologic safety of skin-sparing mastectomy followed by immediate reconstruction in young patients with breast cancer

      2019, Asian Journal of Surgery
      Citation Excerpt :

      After adjusting for stage, there were no statistically significant differences between the two groups with respect to DMFS and BCSS at each stage. Several meta-analyses have concluded that SSM with reconstruction is an oncologically safe procedure, at least for patients with early-stage disease and a small tumor.26,27 However, comparable results have also been obtained for patients with stage III disease.

    • Evolution of Operative Technique for Mastectomy

      2018, Surgical Clinics of North America
    View all citing articles on Scopus
    View full text