title: Skin-sparing mastectomy. specialty bias and worldwide lack of consensus.
abstract: BACKGROUND
  Skin-sparing mastectomy (SSM) is a variation of modified radical mastectomy (MRM) optimized for reconstruction. The authors attempted to determine SSM attitudes and biases within different specialties and countries throughout the world.
  
  
  METHODS
  The authors polled 11,485 individuals via e-mail, including members of surgical, medical, and breast oncology societies, about SSM. Respondents were directed to a survey website where data were directly entered into a database.
  
  
  RESULTS
  Among 1027 respondents, 19 said their knowledge was insufficient to attempt the survey. Surveys were completed by 1008 respondents (8.8%) from 52 countries, comprising 436 (43.3%) surgeons, 376 (37.3%) medical oncologists, 146 (14.5%) radiation oncologists, and 50 (5.0%) individuals from other fields. Of the respondents, 61.9% stated that SSMs are performed at their institution. However 19.1% of these believed that SSM leaves the nipple and areola intact. This perception was higher outside the U.S. (P < 0.0001). Despite knowledge by 77.8% that SSM does not have a higher local disease recurrence rate than MRM, 25.3% of these individuals did not believe the literature. This was most prevalent among radiation oncologists (48.5%), as was the belief that SSM is contraindicated in patients with ductal carcinoma in situ and invasive breast carcinoma (23.3%).
  
  
  CONCLUSIONS
  Despite a developing body of literature, there was variation in opinion among specialties and a lack of understanding of SSM. Many physicians were not familiar with the literature. Among those who were, skepticism was highest among radiation oncologists. Although these results were indicative of only those responding, education about SSM is needed across specialties and in other countries if the procedure is to be widely accepted.
authors.affiliation: John Wayne Cancer Institute, Saint John's Hospital and Health Center, Santa Monica, California 90404, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bleicher
authors.forename: Nora M
authors.initials: NM
authors.lastname: Hansen
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D015411:Mastectomy, Modified Radical / Q000379:methods*; D009558:Nipples / Q000601:surgery; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps