title: Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure.
abstract: OBJECTIVE
  Is skin-sparing mastectomy (SSM) with conservation of the Nipple-Areola Complex (NAC) and immediate autologous reconstruction as safe in oncologic terms as SSM with resection of the NAC as modified radical mastectomy (MRM)?
  
  
  BACKGROUND
  The originally described technique of SSM included the removal of gland, NAC, and biopsy scar. However, the risk of tumor involvement of NAC in patients with breast cancer has been overestimated.
  
  
  METHODS
  Between 1994 and 2000, 286 selected patients with an indication for MRM and tumor margins of greater than 2 cm from the nipple were presented with the alternative of a SSM. Regular follow-up data were evaluable of 112 patients with SSM and 134 patients with MRM. Immediate reconstruction was achieved by latissimus dorsi flap or TRAM flap. The mean follow-up time was 59 (18 to 92) months.
  
  
  RESULTS
  Patients with SSM were significantly younger than those with MRM but were comparable regarding clinical data, tumor parameters, adjuvant treatment, and overall complications. After intraoperative frozen sections of the NAC-ground, the NAC could be conserved in 61 (54.5%) but was resected in 51 (45.5%) of the 112 patients with SSM. The aesthetic results after SSM were evaluated as excellent or good in 91.1% (102/112) patients and were significantly better after preservation of the NAC (P = 0.001). Six (5.4%) recurrences occurred in 112 patients with SSM compared with 11 (8.2%) cases after MRM. Only 1 recurrence in a conserved nipple was treated by wide excision of nipple with conservation of the areola. This patient is still free of disease after 52 months.
  
  
  CONCLUSIONS
  In patients who are candidates for a mastectomy and tumors distant from the nipple, SSM with intraoperative frozen section of the NAC ground offers the opportunity of NAC conservation without increasing the risk of local recurrences.
authors.affiliation: Department of Obstetrics and Gynecology, LMU Munich, Maistrasse 11, 80337 Munich, Germany. bernd.gerber@fk-i.med.uni-muenchen.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
authors.forename: Annette
authors.initials: A
authors.lastname: Krause
authors.forename: Toralf
authors.initials: T
authors.lastname: Reimer
authors.forename: Heiner
authors.initials: H
authors.lastname: Müller
authors.forename: Ingrid
authors.initials: I
authors.lastname: Küchenmeister
authors.forename: Joseph
authors.initials: J
authors.lastname: Makovitzky
authors.forename: Günther
authors.initials: G
authors.lastname: Kundt
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
mesh_terms: D000328:Adult; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009558:Nipples / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome