Abstract
To evaluate the oncological outcomes of patients with breast cancer after nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM), followed by immediate reconstruction, as compared to conventional mastectomy (CM).SSM/NSM has been increasingly used to treat women with breast cancer who wish to preserve the overlying breast skin, but concern exist regarding its oncological safety due to the potential for residual breast tissue. We report our experience performing SSM/NSM for breast cancer treatment compared to CM with a long follow-up period.All consecutive patients who underwent mastectomy for breast cancer at Asan Medical Center between January 1993 and December 2008 were identified by retrospective medical chart review. The patients who underwent NSM/SSM, followed by immediate breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap (TRAM), were compared to the patients who underwent CM in terms of breast-cancer specific survival (BCSS) rate, distant metastasis-free survival (DMFS) rate, and local recurrence (LR) rate.During the study period, 6028 patients underwent mastectomy for breast cancer. Of these, 1032 and 4996 underwent NSM/SSM with TRAM and CM, respectively. Their median follow-up durations were 94.4 (range, 8.1-220.2) and 110.8 (range, 6.1-262.0) months, respectively. Their 5 year BCSS rates were 95.4% and 88.1%, respectively (log-rank, P < .001). Their 5 year DMFS rates were 93.0% and 85.6%, respectively (log-rank, P < .001).Relative to CM, NSM/SSM, followed by immediate breast reconstruction, may be a viable and oncologically safe surgical treatment in selected patients with breast cancer.
Highlights
Breast cancer is the second most common malignancy among women, and its incidence in Korea is increasing rapidly.[1]
All patients with clinical stage 0–III breast cancer had been offered the option of nipple-sparing mastectomy (NSM) or sparing mastectomy (SSM), followed by immediate reconstruction, as an alternative to conventional mastectomy (CM), only the patients who underwent immediate transverse rectus abdominis musculocutaneous flap (TRAM) flap reconstruction were included in this study
Cosmetic outcomes are increasingly being considered because the chance of dying from breast cancer has fallen
Summary
Breast cancer is the second most common malignancy among women, and its incidence in Korea is increasing rapidly.[1]. Many of the breast cancers that are currently detected are in the early stages.[2,3] at the time of diagnosis, many patients still present with diffuse microcalcification or multifocal or multicentric breast cancer. Breastconserving surgery is increasingly being used to treat breast cancer cases, about one-third of women with breast cancer still must undergo mastectomy due to the size of the tumor, the site of the lesion, and/or the extent of the tumor.[4,5,6,7,8,9] Recently in cases of breast cancers, mastectomy with complete preservation of the skin envelope or nipple has been developed to improve aesthetic and psychological outcomes for patients.[10]
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