Outcomes after Total Skin-sparing Mastectomy and Immediate Reconstruction in 657 Breasts

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• 作者：Anne Warren Peled MD (1)
  Robert D. Foster MD (1)
  Allison C. Stover MPH (2)
  Kaoru Itakura BA (2)
  Cheryl A. Ewing MD (2)
  Michael Alvarado MD (2)
  E. Shelley Hwang MD ; MPH (3)
  Laura J. Esserman MD ; MBA (2)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2012
• 出版时间：October 2012
• 年：2012
• 卷：19
• 期：11
• 页码：3402-3409
• 全文大小：247KB
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  6. Margulies AG, Hochberg J, Kepple J, Henry-Tillman RS, Westbrook K, Klimber VS. Total skin-sparing mastectomy without preservation of the nipple–areola complex. / Am J Surg. 2005;190:907-2. CrossRef
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  13. Vaughn CJ, Warren Peled A, Esserman LJ, Foster RD. Feasbility of performing total skin-sparing mastectomy in patients with previous periareolar incisions. Presented at: California Society of Plastic Surgeons Annual Meeting, Coronado, CA, 2012.
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• 作者单位：Anne Warren Peled MD (1)
  Robert D. Foster MD (1)
  Allison C. Stover MPH (2)
  Kaoru Itakura BA (2)
  Cheryl A. Ewing MD (2)
  Michael Alvarado MD (2)
  E. Shelley Hwang MD, MPH (3)
  Laura J. Esserman MD, MBA (2)
  
  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
  2. Department of Surgery, Carol Franc Buck Breast Cancer Center, University of California, San Francisco, CA, USA
  3. Department of Surgery, Duke University Medical Canter, Durham, NC, USA
  

文摘

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.