Skin‐sparing mastectomy

Abstract

BACKGROUNDSkin‐sparing mastectomy (SSM) is a variation of modified radical mastectomy (MRM) optimized for reconstruction. The authors attempted to determine SSM attitudes and biases within different specialties and countries throughout the world.METHODSThe authors polled 11,485 individuals via e‐mail, including members of surgical, medical, and breast oncology societies, about SSM. Respondents were directed to a survey website where data were directly entered into a database.RESULTSAmong 1027 respondents, 19 said their knowledge was insufficient to attempt the survey. Surveys were completed by 1008 respondents (8.8%) from 52 countries, comprising 436 (43.3%) surgeons, 376 (37.3%) medical oncologists, 146 (14.5%) radiation oncologists, and 50 (5.0%) individuals from other fields. Of the respondents, 61.9% stated that SSMs are performed at their institution. However 19.1% of these believed that SSM leaves the nipple and areola intact. This perception was higher outside the U.S. (P < 0.0001). Despite knowledge by 77.8% that SSM does not have a higher local disease recurrence rate than MRM, 25.3% of these individuals did not believe the literature. This was most prevalent among radiation oncologists (48.5%), as was the belief that SSM is contraindicated in patients with ductal carcinoma in situ and invasive breast carcinoma (23.3%).CONCLUSIONSDespite a developing body of literature, there was variation in opinion among specialties and a lack of understanding of SSM. Many physicians were not familiar with the literature. Among those who were, skepticism was highest among radiation oncologists. Although these results were indicative of only those responding, education about SSM is needed across specialties and in other countries if the procedure is to be widely accepted. Cancer 2003. © 2003 American Cancer Society.

Anatomical variations of the axilla

“…Furthermore, it can result in accidental damage to the superficial lymphatic vessels located in the SAT (Suami et al 2007a) as well as in damage to the anastomoses present in this region between the superficial and deeper lymphatic vessels that drain lymph from the upper member (Suami et al 2007b; Pavlista & Eliska 2012), which theoretically may contribute to an increased risk of lymphedema of the arm. Although the optimum thickness of the flap after skin-sparing mastectomy for treatment of breast cancer has been the subject of numerous studies (Torresan et al 2005; Carlson 2011) and controversies (Bleicher et al 2003) because of the risk of local recurrence, determining the thickness of the flap at the surgical incision site for approaching the axillary lymph nodes is a topic that has not been addressed in the literature. The axillary fascia, which is an anatomical landmark that separates the SAT from the axilla itself at its base, is relatively thick and has been identified with “the naked eye” in the vast majority (93%) of cases evaluated.…”

Technical Advances in Skin Sparing Mastectomy

“…Despite numerous studies that have demonstrated the oncological safety of the procedure compared to traditional total mastectomy, there are still concerns about the oncological safety [1, 5–9]. One international survey of over 1,000 surgeons found that 78% of respondents believed that the current published literature demonstrated that SSM does not result in higher local recurrence rates of breast cancer, 25% did not believe the data [9].…”

“…One international survey of over 1,000 surgeons found that 78% of respondents believed that the current published literature demonstrated that SSM does not result in higher local recurrence rates of breast cancer, 25% did not believe the data [9]. Despite these concerns, the utilization of skin sparing mastectomy continues to increase [10].…”

Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes

“…Local recurrence rate after SSM was reported as 3 to 12% [4]. Although concerns regarding local control and appropriate indications were raised [14], the available data do not support an increase in the risk of local recurrence with SSM when an accurate surgical dissection is performed [3,5,6]; and recently, in a meta-analysis of nine studies comprising 3,739 patients [4], no significant difference in local recurrence was noted between 1,104 patients with SSM and IBR, and 2,635 patients with conventional mastectomies without reconstruction. Most of our series included patients with early-stage breast cancer, and only one patient (1.5%) had locally advanced breast cancer.…”