ObjectiveTo examine the incidence of local recurrence (LR) and factors associated with it in a population of patients who underwent skin-sparing mastectomy (SSM) and immediate reconstruction for invasive carcinoma. Summary Background DataThe efficacy of SSM has been challenged by concerns about increased risks of LR. MethodsA consecutive series of 173 patients (176 cancers) with invasive carcinoma underwent SSM and immediate breast reconstruction (June 1986 to December 1997). Data were analyzed by the Kaplan-Meier method, the log-rank statistic test, and the Cox proportional hazards model. ResultsMean patient age was 47 Ϯ 9 years (27% were 40 or younger). The AJCC stages were 1 ϭ 43%, 2 ϭ 52%, and 3 ϭ 5%.Thirty percent of tumors were poorly differentiated. With a median follow-up of 73 months, the LR rate was 4.5%. The mean local relapse-free interval was 26 months. Seventy-five percent of patients who presented with LR developed distant metastases and died of disease within a mean of 21 months. On univariate analysis, factors associated with higher LR rate were tumor stage 2 or 3, tumor size larger than 2 cm, nodepositive disease, and poor tumor differentiation. Actuarial 1-, 3-, and 5-year overall survival rates were 98%, 94%, and 88%, respectively. On multivariate analysis, factors associated with decreased survival were advanced stage, presence of LR, and absence of hormone therapy. LR was a highly significant predictor of tumor-related death. ConclusionsThere is a low incidence of LR after SSM, and it is associated with advanced disease at presentation. LR is an independent risk factor for tumor-related death.Skin-sparing mastectomy (SSM) has been advocated as an oncologically safe approach for the management of patients with early-stage breast cancer. This operation also minimizes deformity and improves cosmesis through preservation of the skin envelope of the breast.1-5 Chest wall skin is a common site of local failure after mastectomy, and the incidence of this event after SSM has been reported to be 0% 5 to 7%. 6 Although the results of SSM have been analyzed in previous reports, many of these series included patients with invasive and noninvasive breast cancer with variable lengths of follow-up. The objective of this study was to examine survival rates, incidence of local recurrence (LR), and factors associated with it in a population of patients who underwent SSM and immediate breast reconstruction for invasive breast cancer at a single institution. METHODSA retrospective review was performed of patients who underwent SSM and immediate breast reconstruction from Correspondence: Marshall M.

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The purpose of this study was to determine the effect of transplanted human mesenchymal stem cells (hMSCs) on wound healing. In this model, full-thickness cutaneous wounds were created by incision in the skin of adult New Zealand white rabbits and treated by transplanted human MSCs into the wounds. Wound healing was evaluated by histologic analysis and tensiometry over time. A total of 15 New Zealand white rabbits with 10 wounds per animal were examined in this study. Animals were treated with human MSCs and euthanized at 3, 7, 14, 21 and 80 days after manipulation. The hMSCs were labeled with a fluorescent dye (CM-DiI), suspended in PBS, and used to treat full-thickness incisional wounds in rabbit skin. Tensiometry and histology was used to characterize the wound-healing rate of the incisional wounds. These results showed that transplanted hMSCs significantly inhibited scar formation and increased the tensile strength of the wounds. Importantly, MSCs from genetically unrelated donors did not appear to induce an immunologic response. In conclusion, human mesenchymal stem cell therapy is a viable approach to significantly affect the course of normal cutaneous wound healing and significantly increase the tensile strength.

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