Die subkutane Mastektomie

Abstract

This is a report on 278 patients who underwent subcutaneous mastectomy (SCM) at the Gynaecological Department of the University Hospital Heidelberg between 1980 and 1996. These operations were indicated either because of diagnostic problems (n = 104), a carcinoma of the contralateral breast (n = 33), non-invasive lobular carcinoma (n = 33), non-invasive ductal carcinoma (n=64), recurrent disease (n=8) or invasive carcinoma (n=36). In the group of patients with diagnostic problems occult lesions were found in 16%. In women with a previously known contralateral carcinoma occult carcinomata were diagnosed in 27%. In cases with a preoperative lobular carcinoma in situ we found ipsilaterally 6% occult invasive carcinoma and in 20% with a preoperatively diagnosed ductal carcinoma in situ. After a median follow up of 16.6 years the local recurrence rate for the invasive carcinoma was 19%, for LCIS was 10% and for DCIS was 3%. The recurrence free survival after 10 years was 91% for DCIS and LCIS and 86% for invasive carcinoma. The overall survival after ten years was 97% for DCIS, 95% for LCIS and 90% for invasive carcinoma. The incidence of invasive breast cancer after prophylactic subcutaneous mastectomy was 1 %. The findings of this study support the use of SCM because of comparable results in local recurrence rates and overall survival with breast conserving therapy and mastectomy, therefore SCM is a further therapeutic option.