Abstract P4-14-05: Skin sparing mastectomy – thorough breast tissue removal leads to a low local recurrence rate of breast cancer

Abstract

Abstract Introduction: Skin sparing mastectomy (SSM) has the dual advantage of being an acceptable treatment for breast cancer as well as preserving a skin envelope for better aesthesis and cosmesis. However, SSM and immediate breast reconstruction for early breast cancer is not based on level-1 evidence. Even though oncological recurrence is equivalent to that with skin removing mastectomies, most studies have only short term follow-ups. Local Recurrence (LR) or the threat of it is becoming an increasing issue for us as 1 in 4 will succumb from local recurrence. We present local recurrence (LR) and systemic recurrence (SR) rates and the aesthetic results following SSM with or without immediate reconstruction. Methods and materials: Over a period of 10 years, 249 patients undergoing SSM with or without immediate reconstruction were identified from a prospectively recorded database and complete details of all their treatments and outcomes were assessed. The reconstructive methods employed included Transverse Rectus Abdominus Myocutaneous (TRAM) flap, Latissimus Dorsi (LD) flap in isolation or along with an implant and subpectoral implant insertion. LR and SR rates were determined. Pathological examination of biopsies from the skin flaps after SSM, were also analysed. Results: Of the 249 patients who underwent SSM, only 34 did not have immediate breast reconstruction. The overall LR and SR rates were 0.4% and 4.4% respectively. 76 patients underwent SSM and TRAM flap reconstruction (1 LR and 5 SR). 33 patients had LD flap reconstruction (no LR and 1 SR). 61 patients were given LD flap reconstruction with implants (no LR and 4 SR). SSM and insertion of sub-pectoral implants was performed on 45 patients (no LR and no SR). 34 patients underwent SSM without immediate reconstruction (no LR, 1 SR). All 249 patients had no evidence of residual breast tissue in subcutaneous flap biopsies. Of the 215 patients who underwent immediate reconstruction, 140 had a good aesthetic result (65%). Individually, TRAM flap and LD flap with implant insertion each produced the best aesthetic result (74%). While reconstructions with LD flaps alone did result in a good aesthetic result in 70% of patients, it also had the poorest aesthetic result (12%) compared to the other three groups. Conclusion: SSM with or without immediate breast reconstruction performed in our unit has shown a very low rate of LR compared to that in literature. In addition, flap biopsies have shown no residual breast tissue in our patients highlighting that thorough removal of breast tissue at skin sparing mastectomy leads to low LR rates. Our systemic recurrence rates are much higher than local recurrence rates, but are still as expected or slightly lower than expected. Our approach therefore achieves thorough removal of breast tissue and we believe that this leads to a low local recurrence rate, but with good aesthetic results. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-05.