title: What is the evidence behind conservative mastectomies?
abstract: BACKGROUND
  Besides the diffusion of breast reconstructive techniques, several "conservative" approaches in mastectomy have been developed, in order to perform an immediate reconstruction with better aesthetic results: the skin-sparing mastectomy (SSM), the nipple-areola complex (NAC)-sparing mastectomy (NSM) and the skin-reducing mastectomy (SRM). During the last decade, SSMs and NSMs have gained widespread acceptance and are currently considered standard treatment for early breast cancer. We would like to investigate the evidence behind this radical shift towards conservative mastectomies, where there has been a renewed interest worldwide.
  
  
  METHODS
  We reviewed English literature by consulting the following databases: Medline, Embase, Cochrane Register of Controlled Trials, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal and Clinicaltrials.gov. The objective is to include any randomized controlled trial (RCT) comparing a "conservative mastectomy" technique to breast conservative surgery or modified radical mastectomy (MRM) for the treatment of early-stage breast cancer. In the absence of randomized trials, we took into account prospective cohorts and retrospective series for a narrative description of available evidence.
  
  
  RESULTS
  Our review included 58 studies [19 prospective cohorts (34%) and 39 retrospective series (66%)] considering NSM and immediate reconstruction and ten studies [1 prospective cohort (10%) and 9 (90%) retrospective series] considering SSM and immediate reconstruction. In the NSM group, 29 studies reported data about complication rates and 42 studies presented data on NAC partial or complete necrosis. In the NSM group 45 studies and all the studies in the SSM group presented data on local and NAC recurrence.
  
  
  CONCLUSIONS
  In order to achieve higher levels of evidence, RCTs comparing conservative mastectomies to traditional mastectomy and breast conservative surgery would be desirable. However we can conclude that conservative mastectomies offer the psychological advantages of good cosmetics and maintenance of woman body image without compromising the oncological safety of mastectomy.
authors.affiliation: 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rocco
authors.affiliation: 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Catanuto
authors.affiliation: 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy.
authors.forename: Maurizio Bruno
authors.initials: MB
authors.lastname: Nava
keywords: Skin-sparing mastectomy (SSM); breast cancer; nipple-sparing mastectomy (NSM)