Local, regional, and systemic recurrence rates in patients undergoing skin-sparing mastectomy compared with conventional mastectomy

Abstract

Background: Although the use of SSM is becoming more common, there are few data on long-term, local-regional, and distant recurrence rates after treatment. The purpose of this study was to examine the rates of local, regional, and systemic recurrence, and survival in breast cancer patients who underwent skin-sparing mastectomy (SSM) or conventional mastectomy (CM) at our institution.

Methods: Patients with stage 0 to III unilateral breast cancer who underwent total mastectomy at our center from 2000 to 2005 were included in this study. Kaplan-Meier curves were calculated, and the log-rank test was used to evaluate the differences between overall and disease-free survival rates in the 2 groups.

Results: Of 1810 patients, 799 (44.1%) underwent SSM and 1011 (55.9%) underwent CM. Patients who underwent CM were older (58.3 vs 49.3 years, P<.0001) and were more likely to have stage IIB or III disease (53.0% vs 31.8%, P<.0001). Significantly more patients in the CM group received neoadjuvant chemotherapy and adjuvant radiation therapy (P<.0001). At a median follow-up of 53 months, 119 patients (6.6%) had local, regional, or systemic recurrences. The local, regional, and systemic recurrence rates did not differ significantly between the SSM and CM groups. After adjusting for clinical TNM stage and age, disease-free survival rates between the SSM and CM groups did not differ significantly.

Conclusions: SSM is an acceptable treatment option for patients who are candidates for immediate breast reconstruction. Local-regional recurrence rates are similar to those of patients undergoing CM. Cancer 2011. © 2010 American Cancer Society.

Figure 1

Choices for skin-sparing mastectomy incisions.(Left) Mastectomy incisions for patients not requiring a mastopexy: Periareolar Incision Only (white circle). The lack of disruption of the circumferential blood supply to the breast skin envelope because of the lack of incision on the breast preserves the circumferential subdermal vascular perfusion. Racquet Handle Incision (white circle plus black line). The lateral breast incision disrupts the circumferential circulation to the remaining breast skin envelope. Periareolar Plus Counter Axillary Incision (white circle plus red and dashed blue line). Extension of axillary incision anteriorly may limit the width of skin-bridge between itself and the periareolar incision that may adversely affect the circumferential vascular perfusion. This may be problematic in patients with a small breast with a large areola, in which the width between the 2 incisions is already narrow. Periareolar Plus Axillary Sentinel Lymph Node Incision (white circle plus red line). Circumferential perfusion is maintained in the subdermal plexus of the breast skin envelope, decreasing the potential for breast skin flap necrosis. The separate axillary sentinel node biopsy incision avoids having to extensively undermine the lateral breast skin flap to access the involved lymph node(s) that may affect perfusion to the breast skin.(Right) Mastectomy incisions for patients requiring a mastopexy. Wise Skin Pattern (dashed black line) incision is not preferred because of the high rate of breast skin flap necrosis that is upwards of 50%. The lateral skin flap is at most risk because of the extensive lateral undermining that is often associated with mastectomy and axillary surgery. Concentric Mastopexy (white oval) incision is preferred because it maintains the circumferential circulation to the breast skin envelope without disruption from associated incisions on the breast. Skin closure results in a short transverse incision that can be camouflaged after reconstruction of the nipple and areola reduction.

Figure 2

Unadjusted disease-free survival rates in patients who underwent SSM vs CM.

Figure 3

Clinical TNM stage adjusted disease-free survival rates in patients undergoing SSM and CM (*P values were calculated by stratified log-rank test).