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The Oncological Safety of Skin Sparing Mastectomy with Conservation of the Nipple-Areola Complex and Autologous Reconstruction: An Extended Follow-Up Study

Gerber, Bernd MD, PhD*; Krause, Annette MD*; Dieterich, Max MD*; Kundt, Günther PhD,†††; Reimer, Toralf MD, PhD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e31819a044f
Original Articles

Objective: To find out if skin sparing mastectomy (SSM) and nipple sparing mastectomy (NSM) with immediate autologous reconstruction as safe in oncological terms as modified radical mastectomy (MRM).

Summary Background: The oncological safety of less radical surgical procedures like SSM and NSM cannot be evaluated by randomized trials. A careful and long lasting follow-up of patients, treated with SSM or NSM, is urgently needed.

Patients and Methods: Between 1994–2000, 246 selected patients with an indication for MRM were treated with SSM, NSM, or MRM. Short term results were published in 2003.1 After a mean follow-up of 101 months (range 32–126), 238 evaluable patients with SSM (N = 48), NSM (N = 60), or MRM (N = 130) were analyzed for local and distant recurrences, breast cancer specific death, and esthetic results.

Results: Local recurrences occurred in 10.4% (SSM), 11.7% (NSM) and 11.5% (MRM) of all patients (P = 0.974). With regard to isolated DM (25.0%, 23.3%, respectively 26.2%; P = 0.916) and breast cancer specific death (20.8%, 21.7%, respectively 21.5%; P = 0.993), there were no significant differences between subgroups. The re-evaluation of esthetic results by surgeons revealed a significant shift from 78.4% excellent results after 59 months to 47.9% after 101 months follow-up (SSM; P = 0.004) and from 73.8% to 51.7% (NSM; P = 0.025). An important risk factor for decreased cosmetic score was application of adjuvant radiotherapy.

Conclusion: In patients who are candidates for a mastectomy, skin sparing mastectomy or nipple sparing mastectomy with immediate autologous reconstruction are oncologically safe techniques. Adjuvant radiotherapy decreases the esthetic results even after a longer period of time.

In Brief

Skin and nipple sparing mastectomies (SSM, NSM) are alternatives to modified radical mastectomy (MRM) in selected patients with indication for MRM. Also, with longer follow-up, SSM and NSM are oncologically as safe as MRM. The initially excellent esthetic results decrease over time, especially after radiotherapy.

Author Information

From the *Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany; and ††Institute of Medical Informatics and Biometry, University of Rostock, Rostock, Germany.

Correspondence Address: Prof. Dr. med. B. Gerber, Department of Obstetrics and Gynecology, University of Rostock, Suedring 81; 18059 Rostock, Germany. Tel: +49 381-4401-4500, Fax: +49 381-4401-4599, E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.