SUBCUTANEOUS MASTECTOMY FOR PRIMARY BREAST-CANCER AND DUCTAL CARCINOMA IN-SITU

Subcutaneous mastectomy (SCM) has been performed in 323 patients with invasive breast cancer or ductal carcinoma in situ (DCIS) over the las t 20 years, This paper assesses the oncological safety of this operati on with particular reference to local recurrences (LR) in the skin fla ps, LR was assessed in the 134 patients who did not receive post-opera tive irradiation to the flaps and were followed up for a minimum of 30 months, The rates of CR were similar for SCM (16%) and for women who underwent simple mastectomy without post-operative irradiation (SM) fo r invasive cancer (14%) over the same time period, both overall and af ter prognostic stratification. In DCIS LR was only found in women trea ted with SCM. Four of the five recurrences (from 33 women) were in the nipple and later in the series patients with microscopic tumour invol vement in the nipple received prophylactic irradiation to the nipple o nly; five patients treated in this may have not suffered LR, Subcutane ous mastectomy followed by insertion of a prosthesis is a safe alterna tive to mastectomy, since it carries no higher risk of LR, It is the s implest form of reconstruction in those proceeding to silicone implant and has the potential of achieving an excellent cosmetic result, Fail ure does not compromise the chance of more complex reconstruction proc edures.