title: Total skin-sparing mastectomy: a systematic review of oncologic outcomes and postoperative complications.
abstract: BACKGROUND
  Despite the potential aesthetic and psychological benefits of total skin-sparing mastectomy (TSSM) with preservation of the nipple-areolar complex (NAC) skin, there is still reluctance to use the technique due to concern for increased recurrence rates or higher postoperative complication rates. The rapidly expanding literature describing outcomes after TSSM enables a comprehensive review of recurrence rates and surgical complications.
  
  
  METHODS
  Studies describing nipple-sparing or TSSM were identified from the MEDLINE and Cochrane databases. Studies that reported oncologic outcomes and/or data on postoperative complications were included.
  
  
  RESULTS
  Twenty-seven studies were identified that met inclusion criteria, representing a total of 3331 mastectomies. Review of oncologic outcomes in the 10 studies (representing 1148 mastectomies) with documented mean/median follow-up of 2 years demonstrated an overall local-regional recurrence rate of 2.8%. Ischemic complications involving the NAC were reported in 24 studies (representing 3091 mastectomies), with 9.1% of cases reported to have some degree of NAC necrosis and 2.0% of cases complicated by complete necrosis leading to NAC loss. Sixteen studies (representing 2213 mastectomies) reported rates of skin flap necrosis, which occurred in 9.5% of cases. Eighty-one percent of the total cases reviewed involved expander-implant reconstruction; in the 16 studies (representing 2343 reconstructions) that reported outcomes after expander-implant reconstruction, overall expander-implant loss was 3.4%.
  
  
  CONCLUSIONS
  There is now a significant body of literature demonstrating low rates of early local-regional recurrence and postoperative complications after TSSM. These data support the use of TSSM techniques, which improve psychological and aesthetic outcomes without compromising therapeutic efficacy.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, †Department of Epidemiology and Biostatistics, and ‡Division of Breast Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Merisa
authors.initials: M
authors.lastname: Piper
authors.forename: Anne Warren
authors.initials: AW
authors.lastname: Peled
authors.forename: Robert D
authors.initials: RD
authors.lastname: Foster
authors.forename: Dan H
authors.initials: DH
authors.lastname: Moore
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
mesh_terms: D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods*; D009558:Nipples; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000209:etiology; D012867:Skin; D016896:Treatment Outcome