Nipple skin-sparing mastectomy is feasible for advanced disease

Eric C. Burdge, James Yuen, Matthew Hardee, Pranjali V. Gadgil, Chandan Das, Ronda Henry-Tillman, Daniela Ochoa, Soheila Korourian, Vicki Klimberg

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: Skin-sparing mastectomy (SSM) or nipple skin-sparing mastectomy (NSSM) are procedures commonly offered as part of the surgical treatment for breast cancer. Each involves a mastectomy with preservation of the skin overlying the breast (in SSM) and often also the skin overlying the nipple-areolar complex (NSSM). At the time of mastectomy, immediate reconstruction with a tissue expander or implant is performed for a more favorable cosmetic outcome. Until now, these procedures have been reserved for low-risk patients and are rarely offered to patients with advanced disease where neoadjuvant chemotherapy and postmastectomy radiation are a planned part of the treatment. We report our experience of SSM and NSSM in such high-risk patients. Methods: This retrospective study from 2001 to 2012 evaluates the outcomes of 527 patients who underwent SSM or NSSM. Sixty patients with advanced disease who underwent neoadjuvant chemotherapy followed by SSM or NSSM with immediate reconstruction and subsequent radiotherapy (RT) were identified. The cosmetic and oncologic outcomes of this patient group were noted. Results: A total of 527 patients in our study group had a total of 1,035 skin-sparing mastectomies (558 NSSM and 477 SSM; 444 patients with bilateral and 83 with unilateral procedures). Of the 60 patients with locally advanced disease, 39 underwent NSSM and 21 underwent SSM. All patients received RT to the diseased side. Mean age of the group was 50.2 ± 10.8 years, with a range of 27-75 years for NSSM and 29-73 years for SSM. The lymph node status was positive in 71.8 % with an average tumor size of 3.8 ± 2.5 cm. The overall radiation-induced complication rate was 38.1 % (8 of 21) in the SSM group and 30.8 % (12 of 39) in the NSSM group. Wound infections and tissue necrosis occurred at a rate of 16.7 %. The implant was removed in 5 % of these cases. Capsular contracture occurred at a rate of 10.2 %. Radiation-related nonbreast complications occurred in 6.7 % of the cases. Examples of these radiation-related nonbreast complications included radiation pneumonitis, stenosis of the superior vena cava requiring venoplasty and severe atypical chest pain thought to be consistent with osteochondritis. The locoregional recurrence rate (median follow-up of 18 months) was 14.3 % (3 of 21) in the SSM group and 10.3 % (4 of 39) in the NSSM group. Conclusions: SSM and NSSM have been offered to patients with relatively low-risk breast cancer as oncologically safe while affording superior cosmesis with one-step immediate reconstruction. Our series demonstrates that either procedure can be offered to patients with more advanced cancers requiring postoperative RT. The complication rates are comparable to those reported for patients undergoing RT after traditional mastectomies.

Original languageEnglish (US)
Pages (from-to)3294-3302
Number of pages9
JournalAnnals of Surgical Oncology
Volume20
Issue number10
DOIs
StatePublished - Oct 2013
Externally publishedYes

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Nipples
Mastectomy
Skin
Radiotherapy
Radiation
Cosmetics
Osteochondritis

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Burdge, E. C., Yuen, J., Hardee, M., Gadgil, P. V., Das, C., Henry-Tillman, R., ... Klimberg, V. (2013). Nipple skin-sparing mastectomy is feasible for advanced disease. Annals of Surgical Oncology, 20(10), 3294-3302. https://doi.org/10.1245/s10434-013-3174-4

Nipple skin-sparing mastectomy is feasible for advanced disease. / Burdge, Eric C.; Yuen, James; Hardee, Matthew; Gadgil, Pranjali V.; Das, Chandan; Henry-Tillman, Ronda; Ochoa, Daniela; Korourian, Soheila; Klimberg, Vicki.

In: Annals of Surgical Oncology, Vol. 20, No. 10, 10.2013, p. 3294-3302.

Research output: Contribution to journalArticle

Burdge, EC, Yuen, J, Hardee, M, Gadgil, PV, Das, C, Henry-Tillman, R, Ochoa, D, Korourian, S & Klimberg, V 2013, 'Nipple skin-sparing mastectomy is feasible for advanced disease', Annals of Surgical Oncology, vol. 20, no. 10, pp. 3294-3302. https://doi.org/10.1245/s10434-013-3174-4
Burdge EC, Yuen J, Hardee M, Gadgil PV, Das C, Henry-Tillman R et al. Nipple skin-sparing mastectomy is feasible for advanced disease. Annals of Surgical Oncology. 2013 Oct;20(10):3294-3302. https://doi.org/10.1245/s10434-013-3174-4
Burdge, Eric C. ; Yuen, James ; Hardee, Matthew ; Gadgil, Pranjali V. ; Das, Chandan ; Henry-Tillman, Ronda ; Ochoa, Daniela ; Korourian, Soheila ; Klimberg, Vicki. / Nipple skin-sparing mastectomy is feasible for advanced disease. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 10. pp. 3294-3302.
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abstract = "Background: Skin-sparing mastectomy (SSM) or nipple skin-sparing mastectomy (NSSM) are procedures commonly offered as part of the surgical treatment for breast cancer. Each involves a mastectomy with preservation of the skin overlying the breast (in SSM) and often also the skin overlying the nipple-areolar complex (NSSM). At the time of mastectomy, immediate reconstruction with a tissue expander or implant is performed for a more favorable cosmetic outcome. Until now, these procedures have been reserved for low-risk patients and are rarely offered to patients with advanced disease where neoadjuvant chemotherapy and postmastectomy radiation are a planned part of the treatment. We report our experience of SSM and NSSM in such high-risk patients. Methods: This retrospective study from 2001 to 2012 evaluates the outcomes of 527 patients who underwent SSM or NSSM. Sixty patients with advanced disease who underwent neoadjuvant chemotherapy followed by SSM or NSSM with immediate reconstruction and subsequent radiotherapy (RT) were identified. The cosmetic and oncologic outcomes of this patient group were noted. Results: A total of 527 patients in our study group had a total of 1,035 skin-sparing mastectomies (558 NSSM and 477 SSM; 444 patients with bilateral and 83 with unilateral procedures). Of the 60 patients with locally advanced disease, 39 underwent NSSM and 21 underwent SSM. All patients received RT to the diseased side. Mean age of the group was 50.2 ± 10.8 years, with a range of 27-75 years for NSSM and 29-73 years for SSM. The lymph node status was positive in 71.8 {\%} with an average tumor size of 3.8 ± 2.5 cm. The overall radiation-induced complication rate was 38.1 {\%} (8 of 21) in the SSM group and 30.8 {\%} (12 of 39) in the NSSM group. Wound infections and tissue necrosis occurred at a rate of 16.7 {\%}. The implant was removed in 5 {\%} of these cases. Capsular contracture occurred at a rate of 10.2 {\%}. Radiation-related nonbreast complications occurred in 6.7 {\%} of the cases. Examples of these radiation-related nonbreast complications included radiation pneumonitis, stenosis of the superior vena cava requiring venoplasty and severe atypical chest pain thought to be consistent with osteochondritis. The locoregional recurrence rate (median follow-up of 18 months) was 14.3 {\%} (3 of 21) in the SSM group and 10.3 {\%} (4 of 39) in the NSSM group. Conclusions: SSM and NSSM have been offered to patients with relatively low-risk breast cancer as oncologically safe while affording superior cosmesis with one-step immediate reconstruction. Our series demonstrates that either procedure can be offered to patients with more advanced cancers requiring postoperative RT. The complication rates are comparable to those reported for patients undergoing RT after traditional mastectomies.",
author = "Burdge, {Eric C.} and James Yuen and Matthew Hardee and Gadgil, {Pranjali V.} and Chandan Das and Ronda Henry-Tillman and Daniela Ochoa and Soheila Korourian and Vicki Klimberg",
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T1 - Nipple skin-sparing mastectomy is feasible for advanced disease

AU - Burdge, Eric C.

AU - Yuen, James

AU - Hardee, Matthew

AU - Gadgil, Pranjali V.

AU - Das, Chandan

AU - Henry-Tillman, Ronda

AU - Ochoa, Daniela

AU - Korourian, Soheila

AU - Klimberg, Vicki

PY - 2013/10

Y1 - 2013/10

N2 - Background: Skin-sparing mastectomy (SSM) or nipple skin-sparing mastectomy (NSSM) are procedures commonly offered as part of the surgical treatment for breast cancer. Each involves a mastectomy with preservation of the skin overlying the breast (in SSM) and often also the skin overlying the nipple-areolar complex (NSSM). At the time of mastectomy, immediate reconstruction with a tissue expander or implant is performed for a more favorable cosmetic outcome. Until now, these procedures have been reserved for low-risk patients and are rarely offered to patients with advanced disease where neoadjuvant chemotherapy and postmastectomy radiation are a planned part of the treatment. We report our experience of SSM and NSSM in such high-risk patients. Methods: This retrospective study from 2001 to 2012 evaluates the outcomes of 527 patients who underwent SSM or NSSM. Sixty patients with advanced disease who underwent neoadjuvant chemotherapy followed by SSM or NSSM with immediate reconstruction and subsequent radiotherapy (RT) were identified. The cosmetic and oncologic outcomes of this patient group were noted. Results: A total of 527 patients in our study group had a total of 1,035 skin-sparing mastectomies (558 NSSM and 477 SSM; 444 patients with bilateral and 83 with unilateral procedures). Of the 60 patients with locally advanced disease, 39 underwent NSSM and 21 underwent SSM. All patients received RT to the diseased side. Mean age of the group was 50.2 ± 10.8 years, with a range of 27-75 years for NSSM and 29-73 years for SSM. The lymph node status was positive in 71.8 % with an average tumor size of 3.8 ± 2.5 cm. The overall radiation-induced complication rate was 38.1 % (8 of 21) in the SSM group and 30.8 % (12 of 39) in the NSSM group. Wound infections and tissue necrosis occurred at a rate of 16.7 %. The implant was removed in 5 % of these cases. Capsular contracture occurred at a rate of 10.2 %. Radiation-related nonbreast complications occurred in 6.7 % of the cases. Examples of these radiation-related nonbreast complications included radiation pneumonitis, stenosis of the superior vena cava requiring venoplasty and severe atypical chest pain thought to be consistent with osteochondritis. The locoregional recurrence rate (median follow-up of 18 months) was 14.3 % (3 of 21) in the SSM group and 10.3 % (4 of 39) in the NSSM group. Conclusions: SSM and NSSM have been offered to patients with relatively low-risk breast cancer as oncologically safe while affording superior cosmesis with one-step immediate reconstruction. Our series demonstrates that either procedure can be offered to patients with more advanced cancers requiring postoperative RT. The complication rates are comparable to those reported for patients undergoing RT after traditional mastectomies.

AB - Background: Skin-sparing mastectomy (SSM) or nipple skin-sparing mastectomy (NSSM) are procedures commonly offered as part of the surgical treatment for breast cancer. Each involves a mastectomy with preservation of the skin overlying the breast (in SSM) and often also the skin overlying the nipple-areolar complex (NSSM). At the time of mastectomy, immediate reconstruction with a tissue expander or implant is performed for a more favorable cosmetic outcome. Until now, these procedures have been reserved for low-risk patients and are rarely offered to patients with advanced disease where neoadjuvant chemotherapy and postmastectomy radiation are a planned part of the treatment. We report our experience of SSM and NSSM in such high-risk patients. Methods: This retrospective study from 2001 to 2012 evaluates the outcomes of 527 patients who underwent SSM or NSSM. Sixty patients with advanced disease who underwent neoadjuvant chemotherapy followed by SSM or NSSM with immediate reconstruction and subsequent radiotherapy (RT) were identified. The cosmetic and oncologic outcomes of this patient group were noted. Results: A total of 527 patients in our study group had a total of 1,035 skin-sparing mastectomies (558 NSSM and 477 SSM; 444 patients with bilateral and 83 with unilateral procedures). Of the 60 patients with locally advanced disease, 39 underwent NSSM and 21 underwent SSM. All patients received RT to the diseased side. Mean age of the group was 50.2 ± 10.8 years, with a range of 27-75 years for NSSM and 29-73 years for SSM. The lymph node status was positive in 71.8 % with an average tumor size of 3.8 ± 2.5 cm. The overall radiation-induced complication rate was 38.1 % (8 of 21) in the SSM group and 30.8 % (12 of 39) in the NSSM group. Wound infections and tissue necrosis occurred at a rate of 16.7 %. The implant was removed in 5 % of these cases. Capsular contracture occurred at a rate of 10.2 %. Radiation-related nonbreast complications occurred in 6.7 % of the cases. Examples of these radiation-related nonbreast complications included radiation pneumonitis, stenosis of the superior vena cava requiring venoplasty and severe atypical chest pain thought to be consistent with osteochondritis. The locoregional recurrence rate (median follow-up of 18 months) was 14.3 % (3 of 21) in the SSM group and 10.3 % (4 of 39) in the NSSM group. Conclusions: SSM and NSSM have been offered to patients with relatively low-risk breast cancer as oncologically safe while affording superior cosmesis with one-step immediate reconstruction. Our series demonstrates that either procedure can be offered to patients with more advanced cancers requiring postoperative RT. The complication rates are comparable to those reported for patients undergoing RT after traditional mastectomies.

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