Evaluation of Residual Glandular Tissue After Skin-Sparing Mastectomies

Torresan, Renato Zocchio; Santos, César Cabello dos; Okamura, Hélio; Alvarenga, Marcelo

doi:10.1245/aso.2005.11.027

Cited by 124 publications

(87 citation statements)

References 20 publications

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“…They found benign breast tissue in 59.5% of their skin flaps, and the presence of residual benign breast tissue was significantly associated with a skin flap thickness of > 5 mm. However, our result and that of Torresan et al 10 are different from that of the study of Slavin et al,11 who performed 144 biopsies (consisting of strips of skin) of native skin flaps after SSM in 32 consecutive patients and found no breast ducts in the dermis of any biopsy. However, since biopsies are incomplete and limited samples of skin flaps and ducts are scattered focally within breast tissue, it should not be surprising that residual breast ducts would not be detected using this method.…”

Section: Discussioncontrasting

confidence: 99%

“…Indeed, in our study, thicker ASMs (likely reflecting greater amounts of breast tissue left behind since a greater amount of tissue was able to be removed before reaching the dermis after the SSM was completed) correlated with positive superficial specimen margins, and 53% of ASMs contained benign breast epithelium. These results are very similar to those reported by Torresan et al 10 These authors first performed an SSM, and then removed the skin flap that would have remained in the patient, essentially converting the procedure to a conventional mastectomy. They found benign breast tissue in 59.5% of their skin flaps, and the presence of residual benign breast tissue was significantly associated with a skin flap thickness of > 5 mm.…”

Section: Discussionsupporting

confidence: 89%

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The Superficial Margin of the Skin-Sparing Mastectomy for Breast Carcinoma: Factors Predicting Involvement and Efficacy of Additional Margin Sampling

et al. 2008

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 89%

The Superficial Margin of the Skin-Sparing Mastectomy for Breast Carcinoma: Factors Predicting Involvement and Efficacy of Additional Margin Sampling

et al. 2008

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“…However, some breast tissue can be left in skin flaps, and the likelihood of residual breast tissue is related to the thickness of the flap. 18 Specimen radiography is important to assess the adequacy of excision. Compression of the specimen should be minimized, as it can severely compromise the ability to assess the distance of the DCIS from the surgical margin.…”

Section: J Marginsmentioning

confidence: 99%

Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group

et al. 2015

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The College does not permit reproduction of any substantial portion of these protocols without its written authorization. The College hereby authorizes use of these protocols by physicians and other health care providers in reporting on surgical specimens, in teaching, and in carrying out medical research for nonprofit purposes. This authorization does not extend to reproduction or other use of any substantial portion of these protocols for commercial purposes without the written consent of the College.The CAP also authorizes physicians and other health care practitioners to make modified versions of the Protocols solely for their individual use in reporting on surgical specimens for individual patients, teaching, and carrying out medical research for non-profit purposes.The CAP further authorizes the following uses by physicians and other health care practitioners, in reporting on surgical specimens for individual patients, in teaching, and in carrying out medical research for non-profit purposes: (1) Dictation from the original or modified protocols for the purposes of creating a text-based patient record on paper, or in a word processing document; (2) Copying from the original or modified protocols into a text-based patient record on paper, or in a word processing document; (3) The use of a computerized system for items (1) and (2), provided that the Protocol data is stored intact as a single text-based document, and is not stored as multiple discrete data fields.Other than uses (1), (2), and (3) above, the CAP does not authorize any use of the Protocols in electronic medical records systems, pathology informatics systems, cancer registry computer systems, computerized databases, mappings between coding works, or any computerized system without a written license from CAP. Applications for such a license should be addressed to the SNOMED Terminology Solutions division of the CAP.Any public dissemination of the original or modified Protocols is prohibited without a written license from the CAP.The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations of surgical specimens. The College regards the reporting elements in the "Surgical Pathology Cancer Case Summary" portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the ...

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“…Torresan et al performed histological analysis of skin sparing mastectomy flaps from patients with invasive breast cancer who were marked up for SSM and then had conventional mastectomy performed and found the prevalence of residual breast tissue to be 59.5% and residual disease to be 9.5% in the portion of the specimen that would have been left in-situ had the patient undergone SSM. The presence of breast tissue and residual disease was significantly associated with skin flaps thicker than 5 mm [58] [59].…”

Section: Oncological Considerationsmentioning

confidence: 99%

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Kasem¹,

Choy²,

Mokbel³

2014

JCT

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Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nippleareola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New techniques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

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Evaluation of Residual Glandular Tissue After Skin-Sparing Mastectomies

Abstract: A high prevalence of glandular breast tissue and residual disease in the skin flap was associated with a skin flap thickness >5 mm.

Cited by 124 publications

References 20 publications

The Superficial Margin of the Skin-Sparing Mastectomy for Breast Carcinoma: Factors Predicting Involvement and Efficacy of Additional Margin Sampling

The Superficial Margin of the Skin-Sparing Mastectomy for Breast Carcinoma: Factors Predicting Involvement and Efficacy of Additional Margin Sampling

Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

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