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Optimizing the total skin-sparing mastectomy.

Akushla Wijayanayagam1, Anjali S Kumar, Robert D Foster

  • 1Carol Franc Buck Breast Care Center, Department of Surgery, University of California, San Francisco, 1600 Divisidero St, Box 1710, San Francisco, CA 94115-1710, USA.

Archives of Surgery (Chicago, Ill. : 1960)
|January 23, 2008
PubMed
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Total skin-sparing mastectomy (TSM) is a feasible breast cancer surgery option, preserving the nipple-areola complex for excellent cosmetic results. This technique may encourage more women to consider mastectomy for risk reduction.

Area of Science:

  • Oncology
  • Plastic Surgery
  • Breast Surgery

Background:

  • Total skin-sparing mastectomy (TSM) involves dissecting subnipple tissue to preserve the entire breast skin envelope.
  • This approach is considered for patients with breast neoplasm or those opting for prophylactic mastectomy.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of TSM with nipple-areola complex (NAC) preservation.
  • To assess the cosmetic results and complication rates associated with TSM.

Main Methods:

  • A prospective study was conducted on 43 women (64 breasts) undergoing TSM.
  • Preoperative MRI was used for patient selection and disease exclusion near the nipple.
  • Immediate reconstruction utilized implants, tissue expanders, or various flap techniques.

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Main Results:

  • Complete NAC skin survival was achieved in 80% of patients, with partial survival in 16%.
  • The radial incision technique demonstrated the highest NAC survival rate (97%).
  • Occult ductal carcinoma in situ was found in the NAC of 3% of patients; no cancer recurrence was observed during the follow-up period.

Conclusions:

  • TSM is a viable surgical option for selected patients with breast neoplasm and for prophylactic mastectomy.
  • The procedure offers excellent cosmetic outcomes and may increase patient willingness to undergo mastectomy for risk reduction.