title: Oncological and aesthetic considerations of skin-sparing mastectomy.
abstract: OBJECTIVE
  To review the oncological safety and aesthetic value of skin-sparing mastectomy (SSM) for invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS). Controversies including the impact of radiotherapy (RT) on immediate breast reconstruction (IBR), preservation of the nipple-areola complex (NAC) and the role of endoscopic mastectomy are also considered.
  
  
  METHODS
  Literature review facilitated by Medline and PubMed databases.
  
  
  RESULTS
  SSM is an oncologically safe technique in selected cases, including IBC <5 cm, multi-centric tumours, DCIS and prophylactic risk-reduction surgery. The high risk of local recurrence (LR) excludes inflammatory breast cancers and tumours with extensive involvement of the skin. SSM can facilitate IBR and is associated with an excellent aesthetic result. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMR) do not preclude SSM, however the cosmetic outcome may be affected. Nipple/areola preservation is possible for remote tumours, employing a frozen section protocol for the retro-areolar tissue. There is limited data available for endoscopic mastectomy and superiority over conventional SSM has not been established.
  
  
  CONCLUSIONS
  In appropriately selected cases SSM is oncologically adequate. There are several patient centred advantages over conventional mastectomy, including aesthetic outcome and the avoidance of multiple staged procedures. Despite widespread uptake into surgical practice, validation of these techniques from randomised controlled trials is lacking.
authors.affiliation: London Breast Institute, The Princess Grace Hospital, London, W1U 5NY, UK.
authors.forename: Neill
authors.initials: N
authors.lastname: Patani
authors.forename: Kefah
authors.initials: K
authors.lastname: Mokbel
mesh_terms: D001828:Body Image; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D004724:Endoscopy; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009558:Nipples / Q000601:surgery; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome