Skin and Nipple-Areola Complex Sparing Mastectomy in Breast Cancer Patients

Abstract

Skin and nipple-areola complex sparing mastectomy (SNSM) and primary reconstruction have been popular for breast cancer treatment in the last decade. An advantage of the SNSM technique is the removal of all breast tissue as a radical surgical procedure while preserving native breast integrity, nipple-areola complex (NAC), and submammary fold. This retrospective 15-year clinical study analyzes medical records from our breast surgery database collected at our department between 1997 and 2012. A total number of 3757 patients were treated for breast cancer; 411 (10.9%) patients had a skin-sparing mastectomy with the median (range) length follow-up of 63 months. This is the longest follow-up for SNSM in breast cancer patients; 3.7% of patients who underwent SNSM developed disease local recurrence, whereas occult NAC involvement with cancer occurred in 7.7% and local recurrence in the NAC in 1.2%. Partial necrosis of the NAC developed in 9.4% and total necrosis in 0.7% of operated breasts. All disease recurrences occurred in the first 10 years of the follow-up period. Local recurrence developed as first recurrence event has longer median cancer-specific survival time of 70 months than those with only distant metastases with 50 months and locoregional plus distant metastases with 35.5 months. The "Omega" pattern incision combines an oncological radical procedure with a lower incidence of skin flap necrosis. Patients reconstructed with autologous tissue were the group most satisfied. SNSM is an oncological safe procedure for breast cancer treatment with low recurrence in properly selected patients.

Managing patients at genetic risk of breast cancer

“…[41][42][43] In patients with breast cancer, the overall breast cancer recurrence rates with nipple-sparing mastectomy are similar to those of traditional mastectomy and breast conservation treatment. 41 In patients at very high risk of breast cancer, risk-reducing operations also reduce the risk of ultimately needing chemotherapy and radiation to treat breast cancer, as the risk of developing breast cancer is signifi cantly lowered.…”

Važnost citološke analize intraoperacijskog otiska baze mamile kod mastektomiranih pacijentica zbog karcinoma dojke

“…Mastektomija se obično radi u pacijentica koje imaju multicentrični ili veliki tumor ili ponovnu pojavu karcinoma nakon konzervativne terapije 8,9 . Osim toga, u pacijentica s pozitivnim genom bRCA-1 i bRCA-2 kod kojih je povećan rizik od nastanka raka dojke radi se profilaktička mastektomija s poštedom kože i mamile uz primarnu rekonstrukciju dojke, ali samo u ustanovama gdje je moguća primarna rekonstrukcija 9,10 , iako postoje i dileme jesu li potrebne profilaktičke operacije u žena s visokim rizikom za rak dojke 11 . Rekonstrukcija dojke poslije mastektomije kod invazivnog raka danas se smatra integralnim dijelom liječenja raka dojke, ali ovisi o že-ljama i potrebama bolesnica 9 .…”

“…Rekonstrukcija dojke poslije mastektomije kod invazivnog raka danas se smatra integralnim dijelom liječenja raka dojke, ali ovisi o že-ljama i potrebama bolesnica 9 . Može biti primarna (imedijatna) i sekundarna (odgođena) s obzirom na vrijeme rekonstrukcije 9 . R. b. Noone 1982. godine objavio je rad u kojem ukazuje na prednosti primarne rekonstrukcije dojke 12 .…”

Nipple-sparing mastectomy in breast cancer patients: The role of adjuvant radiotherapy (Review)

“…According to the reviewed literature, NSM appears a feasible option without an increased risk of locoregional recurrences for selected patients with invasive breast cancer and/or DCIS (12)(13)(14)(15)(16)(19)(20)(21)(22)(23)(24)39,40). Including a wide range of tumor (T) and node (N) stages, and tumor distances from the NAC, the overall NAC recurrence rates were low, ranging from 0-3.7% (Table I).…”

“…The indications of NSM have been extended from a prophylactic scenario and small tumors distant from the NAC to larger and multi-centric tumors (4,5). There are several studies and reviews on NSM (1,2,5-10), a number of which focus on oncological safety (3,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), cosmetic outcome (24)(25)(26)(27)(28)(29) and surgical techniques (24)(25)(26)(27)(28)(29)(30)(31)(32). The role of adjuvant radiotherapy (RT), including dose-fractionation concepts and techniques (6), remains unclear.…”