Retrospective comparison of non-skin-sparing mastectomy and skin-sparing mastectomy with immediate breast reconstruction.

Satoki Kinoshita,Hiroshi Takeyama,Tadashi Akiba,Toshiaki Morikawa,Susumu Kobayashi,Akio Hirano,Shigeya Kyoda,Kimihiro Nojima,Yoshimi Imawari,Meisei Takeishi,Ken Uchida

doi:10.1155/2011/876520

Abstract

Background. We compared Skin-sparing mastectomy (SSM) with immediate breast reconstruction and Non-skin-sparing mastectomy (NSSM), various types of incision in SSM. Method. Records of 202 consecutive breast cancer patients were reviewed retrospectively. Also in the SSM, three types of skin incision were used. Type A was a periareolar incision with a lateral extension, type B was a periareolar incision and axillary incision, and type C included straight incisions, a small elliptical incision (base line of nipple) within areolar complex and axillary incision. Results. Seventy-three SSMs and 129 NSSMs were performed. The mean follow-up was 30.0 (SSM) and 41.1 (NSSM) months. Respective values for the two groups were: mean age 47.0 and 57; seven-year cumulative local disease-free survival 92.1% and 95.2%; post operative skin necrosis 4.1% and 3.1%. In the SSM, average areolar diameter in type A & B was 35.4 mm, 43.0 mm in type C and postoperative nipple-areolar plasty was performed 61% in type A & B, 17% in type C, respectively. Conclusion. SSM for early breast cancer is associated with low morbidity and oncological safety that are as good as those of NSSM. Also in SSM, Type C is far superior as regards cost and cosmetic outcomes.

Highlights

The establishment of modern radical surgery for breast cancer started with standard radical mastectomy, conducted by William Stewart Halsted in 1882
The average time required for mastectomy was 140 minutes in the sparing mastectomy (SSM) group and 130 minutes in the Non-skin-sparing mastectomy (NSSM) group (P = 0.06); the intraoperative blood loss was 212 g in the SSM group and 197 g in the NSSM group (P = 0.5)
Type C is considered far superior as regards cost and cosmetic outcomes, because the patients, who desire to receive postoperative nipple-areolar plasty, are significantly fewer

Summary

Introduction

The establishment of modern radical surgery for breast cancer started with standard radical mastectomy, conducted by William Stewart Halsted in 1882 This procedure consisted of extensive resection of overlying skin centered around the focus of cancer, the entire mammary gland, and the pectoralis major and minor muscles, as well as complete lymph node dissection. It was essential to resect the regional lymph nodes and intervening lymphatics and to remove the entire mammary gland with radical surgery This procedure became the basis for further extension of the surgical procedure, that is, internal mammary and supraclavicular lymph node dissection, after the long-term postoperative results peaked in the 1920– 30s. In SSM, Type C is far superior as regards cost and cosmetic outcomes

Methods

Results

Discussion

Conclusion