title: Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15-year experience.
abstract: Skin and nipple-areola complex sparing mastectomy (SNSM) and primary reconstruction have been popular for breast cancer treatment in the last decade. An advantage of the SNSM technique is the removal of all breast tissue as a radical surgical procedure while preserving native breast integrity, nipple-areola complex (NAC), and submammary fold. This retrospective 15-year clinical study analyzes medical records from our breast surgery database collected at our department between 1997 and 2012. A total number of 3757 patients were treated for breast cancer; 411 (10.9%) patients had a skin-sparing mastectomy with the median (range) length follow-up of 63 months. This is the longest follow-up for SNSM in breast cancer patients; 3.7% of patients who underwent SNSM developed disease local recurrence, whereas occult NAC involvement with cancer occurred in 7.7% and local recurrence in the NAC in 1.2%. Partial necrosis of the NAC developed in 9.4% and total necrosis in 0.7% of operated breasts. All disease recurrences occurred in the first 10 years of the follow-up period. Local recurrence developed as first recurrence event has longer median cancer-specific survival time of 70 months than those with only distant metastases with 50 months and locoregional plus distant metastases with 35.5 months. The "Omega" pattern incision combines an oncological radical procedure with a lower incidence of skin flap necrosis. Patients reconstructed with autologous tissue were the group most satisfied. SNSM is an oncological safe procedure for breast cancer treatment with low recurrence in properly selected patients.
authors.affiliation: From the Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava," Zagreb, Croatia.
authors.forename: Zdenko
authors.initials: Z
authors.lastname: Stanec
authors.forename: Rado
authors.initials: R
authors.lastname: Žic
authors.forename: Srećko
authors.initials: S
authors.lastname: Budi
authors.forename: Sanda
authors.initials: S
authors.lastname: Stanec
authors.forename: Rudolf
authors.initials: R
authors.lastname: Milanović
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Vlajčić
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Roje
authors.forename: Franjo
authors.initials: F
authors.lastname: Rudman
authors.forename: Krešimir
authors.initials: K
authors.lastname: Martić
authors.forename: Rebeka
authors.initials: R
authors.lastname: Held
authors.forename: Gorjanc
authors.initials: G
authors.lastname: Božo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016462:Mammaplasty / Q000379:methods; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis / Q000453:epidemiology / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009558:Nipples / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome