December 12, 2007
Breast Cancer Source

Skin-sparing Mastectomy Carries Low Risk for Breast Cancer Recurrence

Women who undergo skin-sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) have a 2.7% chance of developing local recurrence after 4 years, study findings indicate.

Researchers from the Helsinki University Central Hospital in Finland suggest that SSM and IBR are "oncologically sound" for women with stage 1 and 2 breast cancer, but nevertheless encourage follow-up of these patients at 1, 2, and 5 years post-surgery with clinical examination and imaging.

SSM followed by IBR allows significant improvements in cosmetic and functional outcomes compared with other reconstruction methods, Tuomo Meretoja and colleagues explain in the European Journal of Surgical Oncology.

The operation removes the nipple-areola complex, skin overlying superficial tumors, and any previous surgical biopsy site together with the entire breast parenchyma. It does, however, preserve the native skin envelope, including the inframammary fold, facilitating optimal breast reconstruction, Meretoja and co-workers explain.

Due to the relatively recent introduction of SSM and the less extensive resection of skin compared with conventional mastectomy, concerns persist that SSM might increase the risk for local or regional recurrence.

The researchers examined the records of 146 women aged an average of 48 years with either stage 1 or 2 breast cancer. All women underwent SSM followed by IBR between 1992 and 2006 at Helsinki University Central Hospital.

Patients were monitored for between 2 and 159 months, and for 51 months on average.

Four patients experienced local skin or subcutaneous recurrences and three had regional lymph node recurrences. A further four women developed systemic recurrences.

Local recurrence after mastectomy has generally been regarded as an indicator of poor prognosis, Meretoja et al note. One previous study found that 75% of patients who develop local recurrence after SSM later develop distant metastases and died of disease a mean of 21 months after local recurrence.

In the present study, however, all of the patients who were treated for a local or regional recurrence were disease free after an average of 35 months following the detection and treatment of recurrence.

Notably, two of the four local recurrences were detected by clinical examination alone, whereas one was detected by mammography and one by ultrasound, leading Meretoja and co-workers to recommend routine use of imaging in the follow-up of such patients.