SKIN-SPARING MASTECTOMY - ONCOLOGIC AND RECONSTRUCTIVE CONSIDERATIONS

Objective The authors compared skin-sparing mastectomy and traditional mastectomy both followed by immediate reconstruction in the treatment of breast cancer. Summary Background Data Skin-sparing mastectomy is used increasingly in the treatment of breast cancer to improve the aes thetic results of immediate reconstruction. The oncologic and reconstr uctive outcomes of this procedure have never been analyzed closely. Me thods Institutional experience with 435 consecutive patients who under went total mastectomy and immediate reconstruction from January 1989 t hrough December 1994 was examined. Mastectomies were stratified into s kin-sparing (SSM) and non-skin-sparing (non-SSM) types. Results Three hundred twenty-seven SSMs and 188 non-SSMs were performed. The mean fo llowup was 41.3 months (SSM,37.5 months, non-SSM,48.2 months). Local r ecurrences from invasive cancer occurred after 4.8% of SSMs versus 9.5 % of non-SSMs. Sixty-five percent of patients who underwent SSMs had n othing performed on the opposite breast versus 45% in the group of pat ients who underwent non-SSM (p = 0.0002). Native skin flap necrosis oc curred in 10.7% of patients who underwent SSMs versus 11.2% of patient s who underwent non-SSMs. Conclusions Skin-sparing mastectomy facilita tes immediate breast reconstruction by reducing remedial surgery on th e opposite breast. Native skin flap necrosis is not increased over tha t seen with non-SSM. Skin-sparing mastectomies can be used in the trea tment of invasive cancer without compromising local control.