Expanding the Indications for Total Skin-Sparing Mastectomy: Is It Safe for Patients with Locally Advanced Disease?

Peled, Anne Warren; Wang, Frederick; Foster, Robert D.; Alvarado, Michael; Ewing, Cheryl A.; Sbitany, Hani; Esserman, Laura J.

doi:10.1245/s10434-015-4734-6

Cited by 69 publications

(47 citation statements)

References 30 publications

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“…There have been a number of studies examining the indications for nipple-sparing mastectomy with subsequent increase in the recommendation and utility of NSM in the past decade. [25][26][27] The literature suggests that good potential candidates for NSM are healthy nonsmokers with smaller breasts with no or minimal ptosis and those who are undergoing surgery for risk reduction of for biologically favorable, small, node-negative tumors without evidence of nipple involvement. 28,29 Oncologic safety has been demonstrated in those undergoing NSM as studies have shown local recurrence rate ranging from 2.3-8.2%, comparable to the rates in conventional mastectomy patients.…”

Section: Discussionmentioning

confidence: 99%

Quality of life and sexual well‐being after nipple sparing mastectomy: A matched comparison of patients using the breast Q

Yoon-Flannery¹,

DeStefano

Cruz

et al. 2018

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Quality of life and sexual well‐being after nipple sparing mastectomy: A matched comparison of patients using the breast Q

Yoon-Flannery¹,

DeStefano

Cruz

et al. 2018

Journal of Surgical Oncology

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Autologous reconstruction in NSM is a safe and effective option that achieves an aesthetic, natural-appearing breast in a single stage. 14,15 However, patients undergoing NSM may be more likely to have a low BMI with a paucity of adequate donor site tissue for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies suggest similar recurrence rates with NSM compared with traditional mastectomy techniques. [1][2][3][4][5][6] Moreover, NSM has been demonstrated in multiple studies to be a safe and effective procedure from a reconstructive perspective, with acceptably low rates of NAC necrosis among other complications. [7][8][9][10][11][12] As the indications for NSM continue to be established, the popularity of this procedure has risen among both patients and surgeons.…”

mentioning

confidence: 99%

Stacked Microsurgical Autologous Flap Breast Reconstruction Is an Ideal Option after Unilateral Nipple-Sparing Mastectomy

Frey

Alperovich

Ahn

et al. 2016

J Reconstr Microsurg Open

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Nipple-sparing mastectomy (NSM) is the latest advancement in the treatment of breast cancer, which permits complete preservation of the nipple-areola complex (NAC). Recent studies suggest similar recurrence rates with NSM compared with traditional mastectomy techniques. [1][2][3][4][5][6] Moreover, NSM has been demonstrated in multiple studies to be a safe and effective procedure from a reconstructive perspective, with acceptably low rates of NAC necrosis among other complications. [7][8][9][10][11][12] As the indications for NSM continue to be established, the popularity of this procedure has risen among both patients and surgeons.NSM allows for the complete range of reconstructive procedures, including both prosthetic and autologous options. 13-15 For many patients, NSM with microsurgical autologous reconstruction is an attractive option as it provides for a natural-appearing breast in a single procedure. Keywords► nipple-sparing mastectomy ► autologous reconstruction ► breast cancer AbstractBackground Nipple-sparing mastectomy (NSM) allows for complete preservation of the nipple-areola complex and is increasing in popularity. Autologous options in NSM provide an aesthetic reconstruction in a single stage; however, donor tissue may be scarce in these patients. Stacked microsurgical breast reconstruction, especially in unilateral cases, is an attractive alternative in NSM that is yet to be described. Methods Patients undergoing NSM with stacked autologous flap reconstruction were identified with demographics, intraoperative variables, and outcomes analyzed. Results Six patients who underwent unilateral NSM with stacked autologous free flaps were identified. The average patient age was 50.17 years and body mass index was 21.67. Average follow-up was 28.62 months. Five (83.3%) patients underwent unilateral NSM and reconstruction for a therapeutic indication. The average mastectomy weight was 235.67 grams. All patients were reconstructed with stacked deep inferior epigastric perforator flaps. The average total flap weight was 397.33 grams. Anastomoses in five stacked flaps (83.3%) were performed in an anterograde/retrograde fashion to the internal mammary (IMA) vessels. In one (16.7%) stacked flap, the two flaps were anastomosed in series to the IMA. There were no major complications and three incidences of minor complications. There were no incidences of partial or complete flap loss. The average number of secondary procedures was 0.83 per patient. Conclusion Stacked microsurgical autologous breast flaps provide an optimal reconstruction after NSM and may be considered the reconstruction of choice in patients undergoing unilateral NSM with inadequate donor site tissue for single-flap reconstruction.

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“…For women undergoing immediate reconstruction, skin-sparing mastectomy with or without preservation of the nipple may be performed. Nipple-sparing mastectomy is generally oncologically safe for in situ or stage I and II invasive cancers (30,31). Some factors predicting nipple involvement are a tumor size of greater than 5 cm, a distance from the tumor to the nipple of less than 2.5 cm, negative ER and PR status, and positive HER2 status (32).…”

Section: Breast Cancer Treatment Surgerymentioning

confidence: 99%

Clinical Diagnosis and Management of Breast Cancer

et al. 2016

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The diagnosis and management of breast cancer are undergoing a paradigm shift from a one-size-fits-all approach to an era of personalized medicine. Sophisticated diagnostics, including molecular imaging and genomic expression profiles, enable improved tumor characterization. These diagnostics, combined with newer surgical techniques and radiation therapies, result in a collaborative multidisciplinary approach to minimizing recurrence and reducing treatment-associated morbidity. This article reviews the diagnosis and treatment of breast cancer, including screening, staging, and multidisciplinary management. In this article, we address current approaches to breast cancer diagnosis and management. These approaches include screening recommendations; diagnostic imaging and pathologic assessment to determine the extent of disease; surgery and radiation treatment; and an array of systemic options, such as chemotherapy, endocrine therapy, and targeted agents (Fig. 1). We also consider the potential contribution of functional imaging to a new era of personalized, tumor-specific treatment. BREAST CANCER DIAGNOSIS ScreeningBreast cancer is generally diagnosed through either screening or a symptom (e.g., pain or a palpable mass) that prompts a diagnostic exam. Screening of healthy women is associated with the detection of tumors that are smaller, have lower odds of metastasis, are more amenable to breast-conserving and limited axillary surgery, and are less likely to require chemotherapy (1). This scenario translates to reduced treatment-related morbidity and improved survival.The only screening modality proven to reduce breast cancerspecific mortality is mammography (2). Screening mammography leads to a 19% overall reduction in breast cancer mortality (3), with less benefit for women in their 40s (15%) and more benefit for women in their 60s (32%). As a result, screening mammography is recommended by the American Cancer Society beginning at age 45, or sooner depending on individual preference. The potential negative aspects of screening mammography are falsepositive examinations, radiation exposure, pain, anxiety, and other negative psychologic effects. Mammography has a 61% chance of a false-positive result over a 10-y period for women commencing screening between the ages of 40 y and 50 y. The risk of a falsepositive examination decreases with older age (3). The US Preventative Task Force cited a 15% breast cancer-related mortality reduction for women who were 39-49 y old and a mortality-related benefit from screening between ages 39 and 69. However, the task force released a controversial report recommending only biennial screening mammography for women who were 50-74 y old, excluding younger women to a large extent because of the high rate of false-positive results (4). Mammography for women in the 39-to 49-y-old age group was recommended if indicated after the use of a risk-based model of breast cancer screening, such as the models developed by the Population-Based Research Optimizing Screening Through Personalized Re...

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Expanding the Indications for Total Skin-Sparing Mastectomy: Is It Safe for Patients with Locally Advanced Disease?

Cited by 69 publications

References 30 publications

Quality of life and sexual well‐being after nipple sparing mastectomy: A matched comparison of patients using the breast Q

Quality of life and sexual well‐being after nipple sparing mastectomy: A matched comparison of patients using the breast Q

Stacked Microsurgical Autologous Flap Breast Reconstruction Is an Ideal Option after Unilateral Nipple-Sparing Mastectomy

Clinical Diagnosis and Management of Breast Cancer

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