Oncological considerations of skin-sparing mastectomy

Abstract

Aim: To review evidence concerning the oncological safety of performing skin-sparing mastectomy (SSM) for invasive breast cancer and ductal carcinoma in situ (DCIS). Furthermore, the evidence concerning RT in relation to SSM and the possibility of nipple preservation was considered.

Methods: Literature review facilitated by Medline and PubMed databases.

Findings: Despite the lack of randomised controlled trials, SSM has become an accepted procedure in women undergoing mastectomy and immediate reconstruction for early breast cancer. Compared to non-skin-sparing mastectomy (NSSM), SSM seems to be oncologically safe in patients undergoing mastectomy for invasive tumours smaller than 5 cm, multicentric tumours, DCIS or risk-reduction. However, the technique should be avoided in patients with inflammatory breast cancer or in those with extensive tumour involvement of the skin in view of the high risk of local recurrence. SSM with nipple areola complex (NAC) preservation appears to be oncologically safe, provided the tumour is not close to the nipple and a frozen section protocol for the retro-areolar tissue is followed. Although radiotherapy (RT) does not represent a contraindication to SSM, the latter should be used with caution if postoperative RT is likely, since it detracts from the final cosmetic outcome.

Figure 1

The peri-areola incision of standard skin-sparing mastectomy.

Figure 2

A: This 40 year old woman had left SSM and immediate LD flap reconstruction for DCIS last year. She is due to have nipple reconstruction shortly. B, C, and D: This 52 year old woman had right SSM and LD flap reconstruction followed by nipple reconstruction using a local skin flap (Trefoil technique) and subsequent tattooing 3 years ago.

Figure 3

This 42 year old doctor had left skin-sparing mastectomy and immediate breast reconstruction using the latissimus dorsi myocutaneous flap and implant 2 years ago, followed by a nipple reconstruction using the nipple-sharing technique and tattooing.