title: Prediction of margin involvement and local recurrence after skin-sparing and simple mastectomy.
abstract: Skin-sparing mastectomy (SSM) facilitates immediate breast reconstruction. We investigated locoregional recurrence rates after SSM compared with simple mastectomy and the factors predicting oncological failure.
  
  
  
  Patients with early breast cancer that underwent mastectomy between 2000 and 2005 at a single institution were studied to ascertain local and systemic recurrence rates between groups. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival.
  
  
  
  Patients (n = 577) underwent simple mastectomy (80%) or SSM (20%). Median follow up was 80 months. Patients undergoing SSM were of younger average age, less often had involved lymph nodes (22% vs 44%, p < 0.001), more often had DCIS present (79% vs 53%, p < 0.001) and involved margins (29% vs 15%, p = 0.001). Involved surgical margins were associated with large size (p = 0.001). The 8-year local recurrence (LR) rates were 7.9% for SSM and 5% for simple mastectomy respectively (p = 0.35). Predictors of locoregional recurrence were lymph node involvement (HR 8.0, for >4 nodes, p < 0.001) and involved surgical margins (HR 3.3, p = 0.002). In node negative patients, SSM was a predictor of locoregional recurrence (HR 4.8 [1.1, 19.9], p = 0.033).
  
  
  
  Delayed reconstruction is more appropriate for node positive early breast cancer after post-mastectomy radiotherapy. Re-excision of involved margins is essential to prevent local recurrence after mastectomy.
authors.affiliation: Department of Academic Breast Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Al-Himdani
authors.affiliation: Department of Academic Breast Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Timbrell
authors.affiliation: Department of Academic Breast Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: K T
authors.initials: KT
authors.lastname: Tan
authors.affiliation: Department of Medical Statistics, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Morris
authors.affiliation: Department of Academic Breast Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK. Electronic address: bundredn@manchester.ac.uk.
authors.forename: N J
authors.initials: NJ
authors.lastname: Bundred
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D000072662:Margins of Excision; D015413:Mastectomy, Simple / Q000009:adverse effects; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin
keywords: Breast cancer; Breast reconstruction; DCIS; Local recurrence; Mastectomy; Surgical margins