Abstract
Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nipple-areola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New tech-niques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.
Highlights
Breast-conserving surgery with adjuvant radiotherapy is a safe alternative to mastectomy for the majority of women with early breast cancer (BC) [1]
Numerous retrospective and prospective studies have supported the growing evidence that sparing mastectomy (SSM) is oncologically safe for early-stage invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) with aesthetic and psychological benefits
The nipple-areola complex (NAC) can be preserved provided that the tumour is node negative, and located more than 2 cm away from the nipple and an intraoperative frozen-section of retroareolar tissue is examined
Summary
Breast-conserving surgery with adjuvant radiotherapy is a safe alternative to mastectomy for the majority of women with early breast cancer (BC) [1]. Up to one third of patients require a mastectomy for large or multi-focal tumours ( where breast conservation would lead to a poor cosmetic outcome), local recurrence after previous radiotherapy and patient preference [2]. The primary aim of surgical treatment of breast cancer is to achieve local control of disease with a good aesthetic result and to provide prognostic information in order to guide adjuvant treatment recommendations. Delay breast reconstruction may result in a poorly contoured breast, with prominent scars and a paddle of skin that is of a different colour and texture [3].
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