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Aim: To review the oncological safety and aesthetic advantage of skin-sparing mastectomy (SSM) for invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS). Controversies including the impact of radiotherapy (RT) on immediate breast reconstruction (IBR), preservation of the nipple-areola complex (NAC) and the role of endoscopic mastectomy are also considered. Methods: Literature review using Medline and PubMed. Results: SSM is safe in selected cases; including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancers and tumours with extensive involvement of the skin represent contra-indications to SSM due to an unacceptable risk of local recurrence. SSM can facilitate IBR and is associated with an excellent aesthetic result. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM, however the cosmetic outcome may be adversely affected. Nipple/areola preservation is safe for peripherally located node negative tumours. A frozen section protocol for the retro-areolar tissue should be considered in these cases. The advent of acellular tissue matrix systems has widened the applicability of implant-based immediate reconstruction following SSM. Data on endoscopic mastectomy is limited and superiority over conventional SSM has not been demonstrated. Conclusion: SSM is safe in selected cases and is associated with advantages over simple mastectomy, including a superior aesthetic outcome and a potential reduction in the number of reconstructive procedures per patient.
carcinoma in-situ DCIS is a
heterogeneous entity in breast neoplasm with unpredictable biological behavior.
This poses challenge in the management of DCIS. Various trials on DCIS have
shown good outcome with integral treatment of adequate surgery, radiotherapy
and hormonal therapy. Identification of subgroup of DCIS for radiotherapy and
hormonal therapy could improve recurrence rate, contralateral tumours incidence
and perhaps overall survival. Various risk score calculations could help to
direct radiotherapy and hormonal treatment verses surgery alone and to avoid
over treatment. Oncotype DX
assay could be a new way of risk calculation to direct types of DCIS treatment.
The recent increased use of MRI could increase the detection of DCIS and a more
accurate extent of disease estimation. This article is a summary of major
literatures and major trials result for DCIS.
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