title: Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism?
abstract: BACKGROUND
  Long-term follow-up of the use of skin-sparing mastectomy (SSM) in the treatment of breast cancer is presented to determine the impact of local recurrence (LR) on survival.
  
  
  METHODS
  A total of 539 patients were treated for 565 cases of breast cancer by SSM and immediate breast reconstruction from January 1, 1989 to December 31, 1998. The American Joint Committee on Cancer pathological staging was stage 0 175 (31%), stage I 135 (23.9%), stage II 173 (30.6%), stage III 54 (9.6%), stage IV 8 (1.4%), and recurrent 20 (3.5%). The mean follow-up was 65.4 months (range, 23.7-86.3 months). Five patients were lost to follow-up.
  
  
  RESULTS
  Thirty-one patients developed a LR during the follow-up including five who received adjuvant radiation. The distribution of LR stratified by cancer stage was stage 0 1, stage I 5, stage II 17, stage III 6, and recurrent 2. The overall LR was 5.5%. Twenty-four patients (77.4%) developed a systemic relapse and 7 (22.6%) patients remained free of recurrent disease at a mean follow-up of 78.1 months. The cancer stage of those remaining disease free was stage 0 1 (100%), stage I 4 (80%), and stage II 2 (11.8%).
  
  
  CONCLUSIONS
  LR of breast cancer after SSM is not always associated with systemic relapse.
authors.affiliation: Winship Cancer Institute, Atlanta, Georgia 30322, USA. grant_carlson@emory.org
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Toncred M
authors.initials: TM
authors.lastname: Styblo
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lyles
authors.forename: John
authors.initials: J
authors.lastname: Bostwick
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Murray
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: William C
authors.initials: WC
authors.lastname: Wood
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome