title: Skin involvement in invasive breast carcinoma: safety of skin-sparing mastectomy.
abstract: BACKGROUND
  There is concern about the oncological safety of preserving most of the breast skin in skin-sparing mastectomy (SSM). Most supportive evidence for SSM evaluates the local recurrence rate on clinical follow-up.
  
  
  METHODS
  The skin and 10 mm of the subcutaneous tissue of 30 total mastectomy specimens were studied with a step-serial sectioning technique. The incidence and mode of involvement of the skin and subcutaneous tissue were recorded in detail. This was correlated with other clinical and pathologic parameters.
  
  
  RESULTS
  The incidence of skin involvement outside the nipple-areola complex was 20% (6 of 30). This was significantly related to the clinical T stage, site of the tumor, skin tethering, pathologic tumor size, and perineural infiltration. When the effects of both skin and subcutaneous tissue involvement were considered, the incidence of skin-flap involvement outside the nipple-areola complex was 23% (7 of 30). The significant parameters related to skin-flap involvement were skin tethering (75% vs. 15%; P <.05), pathologic tumor size (P <.03), and perineural infiltration (63% vs. 9%; P <.01).
  
  
  CONCLUSIONS
  It would be oncologically safe to perform SSM in T1 and T2 tumors, because the chance of skin involvement is small. It is safe to preserve the skin overlying the tumor if there is no skin tethering.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Kwong Wah Hospital, Hong Kong SAR, China. hocm@ha.org.hk
authors.forename: Chiu M
authors.initials: CM
authors.lastname: Ho
authors.forename: Colin K L
authors.initials: CK
authors.lastname: Mak
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lau
authors.forename: Wing Y
authors.initials: WY
authors.lastname: Cheung
authors.forename: Miranda C M
authors.initials: MC
authors.lastname: Chan
authors.forename: Wai K
authors.initials: WK
authors.lastname: Hung
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012449:Safety; D012878:Skin Neoplasms / Q000453:epidemiology; D013524:Surgical Flaps; D016896:Treatment Outcome