title: The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study.
abstract: OBJECTIVE
  To find out if skin sparing mastectomy (SSM) and nipple sparing mastectomy (NSM) with immediate autologous reconstruction as safe in oncological terms as modified radical mastectomy (MRM).
  
  
  BACKGROUND
  The oncological safety of less radical surgical procedures like SSM and NSM cannot be evaluated by randomized trials. A careful and long lasting follow-up of patients, treated with SSM or NSM, is urgently needed.
  
  
  METHODS
  Between 1994-2000, 246 selected patients with an indication for MRM were treated with SSM, NSM, or MRM. Short term results were published in 2003. After a mean follow-up of 101 months (range 32-126), 238 evaluable patients with SSM (N = 48), NSM (N = 60), or MRM (N = 130) were analyzed for local and distant recurrences, breast cancer specific death, and esthetic results.
  
  
  RESULTS
  Local recurrences occurred in 10.4% (SSM), 11.7% (NSM) and 11.5% (MRM) of all patients (P = 0.974). With regard to isolated DM (25.0%, 23.3%, respectively 26.2%; P = 0.916) and breast cancer specific death (20.8%, 21.7%, respectively 21.5%; P = 0.993), there were no significant differences between subgroups. The re-evaluation of esthetic results by surgeons revealed a significant shift from 78.4% excellent results after 59 months to 47.9% after 101 months follow-up (SSM; P = 0.004) and from 73.8% to 51.7% (NSM; P = 0.025). An important risk factor for decreased cosmetic score was application of adjuvant radiotherapy.
  
  
  CONCLUSIONS
  In patients who are candidates for a mastectomy, skin sparing mastectomy or nipple sparing mastectomy with immediate autologous reconstruction are oncologically safe techniques. Adjuvant radiotherapy decreases the esthetic results even after a longer period of time.
authors.affiliation: Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany. bernd.gerber@med.uni-rostock.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
authors.forename: Annette
authors.initials: A
authors.lastname: Krause
authors.forename: Max
authors.initials: M
authors.lastname: Dieterich
authors.forename: Günther
authors.initials: G
authors.lastname: Kundt
authors.forename: Toralf
authors.initials: T
authors.lastname: Reimer
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009558:Nipples; D016896:Treatment Outcome