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Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts.

Publication ,  Journal Article
Warren Peled, A; Foster, RD; Stover, AC; Itakura, K; Ewing, CA; Alvarado, M; Hwang, ES; Esserman, LJ
Published in: Ann Surg Oncol
October 2012

BACKGROUND: Total skin-sparing mastectomy (TSSM), a technique comprising removal of all breast and nipple tissue while preserving the entire skin envelope, is increasingly offered to women for therapeutic and prophylactic indications. However, standard use of the procedure remains controversial as a result oft concerns regarding oncologic safety and risk of complications. METHODS: Outcomes from a prospectively maintained database of patients undergoing TSSM and immediate breast reconstruction from 2001 to 2010 were reviewed. Outcome measures included postoperative complications, tumor involvement of the nipple-areolar complex (NAC) on pathologic analysis, and cancer recurrence. RESULTS: TSSM was performed on 657 breasts in 428 patients. Indications included in situ cancer [111 breasts (16.9%)], invasive cancer [301 breasts (45.8%)], and prophylactic risk-reduction [245 breasts (37.3%)]. A total of 210 patients (49%) had neoadjuvant chemotherapy, 78 (18.2%) had adjuvant chemotherapy, and 114 (26.7%) had postmastectomy radiotherapy. Nipple tissue contained in situ cancer in 11 breasts (1.7%) and invasive cancer in 9 breasts (1.4%); management included repeat excision (7 cases), NAC removal (9 cases), or radiotherapy without further excision (4 cases). Ischemic complications included 13 cases (2%) of partial nipple loss, 10 cases (1.5%) of complete nipple loss, and 78 cases (11.9%) of skin flap necrosis. Overall locoregional recurrence rate was 2% (median follow-up 28 months), with a 2.4% rate observed in the subset of patients with at least 3 years' follow-up (median 45 months). No NAC skin recurrences were observed. CONCLUSIONS: In this large, high-risk cohort, TSSM was associated with low rates of NAC complications, nipple involvement, and locoregional recurrence.

Duke Scholars

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2012

Volume

19

Issue

11

Start / End Page

3402 / 3409

Location

United States

Related Subject Headings

  • Young Adult
  • Surgical Flaps
  • Skin
  • Reoperation
  • Radiotherapy, Adjuvant
  • Organ Sparing Treatments
  • Oncology & Carcinogenesis
  • Nipples
  • Neoplasm, Residual
  • Neoplasm Recurrence, Local
 

Citation

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Warren Peled, A., Foster, R. D., Stover, A. C., Itakura, K., Ewing, C. A., Alvarado, M., … Esserman, L. J. (2012). Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol, 19(11), 3402–3409. https://doi.org/10.1245/s10434-012-2362-y
Warren Peled, Anne, Robert D. Foster, Allison C. Stover, Kaoru Itakura, Cheryl A. Ewing, Michael Alvarado, E Shelley Hwang, and Laura J. Esserman. “Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts.Ann Surg Oncol 19, no. 11 (October 2012): 3402–9. https://doi.org/10.1245/s10434-012-2362-y.
Warren Peled A, Foster RD, Stover AC, Itakura K, Ewing CA, Alvarado M, et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 2012 Oct;19(11):3402–9.
Warren Peled, Anne, et al. “Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts.Ann Surg Oncol, vol. 19, no. 11, Oct. 2012, pp. 3402–09. Pubmed, doi:10.1245/s10434-012-2362-y.
Warren Peled A, Foster RD, Stover AC, Itakura K, Ewing CA, Alvarado M, Hwang ES, Esserman LJ. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 2012 Oct;19(11):3402–3409.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2012

Volume

19

Issue

11

Start / End Page

3402 / 3409

Location

United States

Related Subject Headings

  • Young Adult
  • Surgical Flaps
  • Skin
  • Reoperation
  • Radiotherapy, Adjuvant
  • Organ Sparing Treatments
  • Oncology & Carcinogenesis
  • Nipples
  • Neoplasm, Residual
  • Neoplasm Recurrence, Local