title: Comparison of Local Recurrence After Simple and Skin-Sparing Mastectomy Performed in Patients with Ductal Carcinoma In Situ.
abstract: BACKGROUND
  The incidence of ductal carcinoma in situ (DCIS) is increasing with the use of screening mammography, and approximately 30% of all women diagnosed with DCIS are treated by mastectomy. There is increasing use of a skin-sparing mastectomy (SSM) approach to surgically excise DCIS as this facilitates immediate breast reconstruction. The rates of locoregional recurrence (LRR) after simple mastectomy performed for pure DCIS are historically reported as 1%; however, international data suggest that LRR after SSM may be higher.
  
  
  METHODS
  To determine our rates of LRR and compare the effect of the type of mastectomy performed, we undertook a retrospective review of all patients who underwent a mastectomy for pure DCIS at our institution between 2000 and 2010.
  
  
  RESULTS
  In total, 199 patients underwent a mastectomy for pure DCIS (with eight local recurrences), all of which were invasive ductal carcinoma. The recurrences all occurred after SSM, which was associated with a higher 5-year LRR of 5.9% (5/102) compared with 0% in the simple mastectomy group (0/97; p = 0.012), log-rank. Univariate analysis showed the two factors that predicted the risk of recurrence were a young age at mastectomy and close or involved margins.
  
  
  CONCLUSIONS
  These data highlight the importance of achieving clear margins, especially in young women with estrogen receptor-negative DCIS who have a higher risk of invasive recurrence. Women undergoing a mastectomy for DCIS should be counseled as to the importance of achieving clear margins and the potential increased need for further excision, post-mastectomy radiotherapy and post-reconstruction mammography in order to prevent LRR after SSM.
authors.affiliation: Academic Surgery, University Hospital of South Manchester, Manchester, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Timbrell
authors.affiliation: Academic Surgery, University Hospital of South Manchester, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Al-Himdani
authors.affiliation: Academic Surgery, University Hospital of South Manchester, Manchester, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Shaw
authors.affiliation: Academic Surgery, University Hospital of South Manchester, Manchester, UK.
authors.forename: Kian
authors.initials: K
authors.lastname: Tan
authors.affiliation: Academic Surgery, University Hospital of South Manchester, Manchester, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.affiliation: Academic Surgery, University Hospital of South Manchester, Manchester, UK. nbundred@manchester.ac.uk.
authors.forename: Nigel
authors.initials: N
authors.lastname: Bundred
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000072662:Margins of Excision; D015413:Mastectomy, Simple / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D018365:Neoplasm, Residual; D059351:Organ Sparing Treatments; D012189:Retrospective Studies; D012307:Risk Factors