TITLE:
Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice
AUTHORS:
Abdul Kasem, Christina Choy, Kefah Mokbel
KEYWORDS:
Skin-Sparing Mastectomy; Breast Reconstruction
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.3,
March
25,
2014
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.