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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*

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.

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.

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.