Oncologic Safety of Nipple Skin-Sparing or Total Skin-Sparing Mastectomies With Immediate Reconstruction

BACKGROUND: Success with skin-sparing mastectomy (SSM) has led to the reconsideration of the necessity to remove the skin overlying the nipple-areola complex. The aim of our study was to compare complications and local recurrence in patients undergoing SSM and total skin-sparing mastectomy (TSSM) with immediate reconstruction. METHODS: This IRB-approved retrospective study involved patients who underwent mastectomy with reconstruction (1998 to 2010). Patient demographics, tumor characteristics, type of surgery, cosmesis, postoperative complications, and recurrence were analyzed. RESULTS: The 293 patients in our study group had a total of 508 procedures: 281 TSSMs and 227 SSMs, distributed among 215 patients with bilateral procedures and 78 with unilateral operations. Mean age was 51.2 +/- 10.9 years for TSSM and 53.1 +/- 11.5 years for SSM. The average tumor size was 1.9 +/- 1.6 cm for TSSM versus 2.1 +/- 1.7 cm for the SSM group. The overall complication rate (TSSM 7.1% [20 of 281] and SSM 6.2% [14 of 227], p = 0.67) and local-regional recurrence rate (TSSM6%[7 of 152] and SSM 5.0% [7 of 141], p = 0.89) were comparable. The TSSM rating was significantly higher (score 9.2 +/- 1.1) than the SSM group (score 8.3 +/- 1.9, p = 0.04). CONCLUSION: TSSM appears to be oncologically safe with superior cosmesis, affords one-step immediate reconstruction, and can be offered to patients with stages I and II breast cancer and those who have been down-staged with neoadjuvant chemotherapy. (J Am Coll Surg 2011;212:686-695. (C) 2011 by the American College of Surgeons)