Comparison of Local Recurrence After Simple and Skin-Sparing Mastectomy Performed in Patients with Ductal Carcinoma In Situ

Abstract

BackgroundThe incidence of ductal carcinoma in situ (DCIS) is increasing with the use of screening mammography, and approximately 30% of all women diagnosed with DCIS are treated by mastectomy. There is increasing use of a skin-sparing mastectomy (SSM) approach to surgically excise DCIS as this facilitates immediate breast reconstruction. The rates of locoregional recurrence (LRR) after simple mastectomy performed for pure DCIS are historically reported as 1%; however, international data suggest that LRR after SSM may be higher.MethodsTo determine our rates of LRR and compare the effect of the type of mastectomy performed, we undertook a retrospective review of all patients who underwent a mastectomy for pure DCIS at our institution between 2000 and 2010. ResultsIn total, 199 patients underwent a mastectomy for pure DCIS (with eight local recurrences), all of which were invasive ductal carcinoma. The recurrences all occurred after SSM, which was associated with a higher 5-year LRR of 5.9% (5/102) compared with 0% in the simple mastectomy group (0/97; p = 0.012), log-rank. Univariate analysis showed the two factors that predicted the risk of recurrence were a young age at mastectomy and close or involved margins.ConclusionsThese data highlight the importance of achieving clear margins, especially in young women with estrogen receptor-negative DCIS who have a higher risk of invasive recurrence. Women undergoing a mastectomy for DCIS should be counseled as to the importance of achieving clear margins and the potential increased need for further excision, post-mastectomy radiotherapy and post-reconstruction mammography in order to prevent LRR after SSM.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5673-6) contains supplementary material, which is available to authorized users.

Prediction of pathological margin status using preoperative contrast-enhanced MRI in patients with early breast cancer who underwent skin-sparing mastectomy

“…However, compared to standard mastectomy, IBR with preservation of the entire skin envelope has raised concerns about the oncological safety of SSM in terms of local recurrence . The local recurrence rate (skin and lymph node) after SSM was reported to be between 3.3% and 7.0% in previous papers and we frequently experienced similar outcomes . From an oncological point of view, it is necessary for SSM to be performed safely.…”

Whither surgical quality assurance of breast cancer surgery (surgical margins and local recurrence) after paterson

“…Many series do not report on margin involvement. Reported margin involvement rates in both Europe and USA after mastectomy are low (1-7%) compared to reported UK rates of up to 29% [3][4][5][6][7].…”

“…A UK study of patients with DCIS found a LRR of 5.9% in patients undergoing mastectomy and reconstruction with margin involvement a major predictor for LRR. [5] Most of the literature assessing the oncological safety of mastectomy and immediate breast reconstruction comes from single centres with an institutional policy on management of margins. Many series do not report on margin involvement.…”

Breast cancer recurrence after reconstruction: know thine enemy

“…However, it was reported that 0 of 44 patients with ductal carcinoma in situ (DCIS) relapsed upon SSM, while 10 out of 177 with invasive ductal carcinoma presented relapse within 10 years [ 14 ]. When it does occur, DCIS relapse with SSM has been correlated with the young age of the mastectomy patients [ 15 ].…”