title: Surgical and oncological outcome after skin-sparing mastectomy and immediate breast reconstruction.
abstract: BACKGROUND
  We present clinical outcomes after SSM in operable breast cancer especially in light of increased diagnoses of in situ disease after screening and increased usage of adjuvant aromatase inhibitors (AIs) in recent years.
  
  
  METHODS
  Case records of 81 patients who had SSM for cancer over 4 years (April 2006-July 2010) were reviewed.
  
  
  RESULTS
  Eighty-one patients (median age, 51.7 years; range, 31.5-66.1 years) had 82 SSMs with immediate breast reconstruction (IBR) (59 implant-based; 23 latissimus dorsi flap). Median tumor size was 22 mm (range, 1-86 mm) including in situ disease, and tumor types were invasive (n = 48) and noninvasive (n = 34). Median clearance margin was 5 mm (range, 0-45 mm). Sentinel node was positive in 15 SSM (19.5%) excluding 5 in pure in situ disease. Median Nottingham prognostic index was 3.54 (range, 2.1-6.98), 84% were estrogen receptor-positive (pure in situ, 70.6%), and 8.5% were HER2-positive. Radiotherapy to breast was given to 17.1% of patients and 37.8% of patients received hormone therapy (tamoxifen, 24.4%; upfront AI, 4.9%; switch regime, 8.5% [ie, tamoxifen to exemestane at 2 years). Eight patients (9.6%) had infection/wound healing problems with loss of implant in 3 (3.6%). At median follow-up of 23.9 months (range, 9-64), there was 1 local with systemic (liver) and 1 SR only (brain and liver) after invasive disease with median disease-free survival of 24.4 months (range, 6.1-61.9).
  
  
  CONCLUSIONS
  Despite less use of AIs in our series, the local recurrence (2%) and SR (4%) rates were less than reported in the literature for invasive tumors. This suggests that SSM provides opportunity for enhanced esthetic outcome with IBR without compromise of the local oncological safety compared with conventional simple mastectomy.
authors.affiliation: Division of Breast Surgery, University of Nottingham, Royal Derby Hospital, Derby, UK; Nottingham Breast Institute, Nottingham, UK. Electronic address: docagrawal@hotmail.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.forename: Mandeep
authors.initials: M
authors.lastname: Grewal
authors.forename: David M
authors.initials: DM
authors.lastname: Sibbering
authors.forename: Carol-Ann
authors.initials: CA
authors.lastname: Courtney
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods*; D011446:Prospective Studies; D012867:Skin; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Breast; Immediate breast reconstruction; Oncoplastic; Skin sparing mastectomy