Skin Sparing Mastectomy and Adenomastectomy: Follow Up of the First 93 Cases

INTRODUCTION: Surgical treatment of breast cancer has evolved considerably in recent years with the development of the concepts of immediate breast reconstruction, prophylactic mastectomy and symetrization. Based on these concepts the techniques of skin-sparing mastectomy and adenomastectomy (subcutaneous mastectomy with nipple areola complex – NAC - preservation) are rising as important options in clinical practice. The published data shows good cosmetic results, although there are no randomized studies comparing the safety of this procedure in breast cancer patients. MATERIAL AND METHODS: The performance of skin-sparing mastectomy and adenomastectomy began in 2006 in Centro de Mama da PUC/RS, Brazil. The objectives of this study are to describe the sociodemographic profile, tumor characteristics and outcome of the first 93 cases operated between 2006 and 2010. Inclusion criteria were female gender, surgical conditions to preserve skin and / or NAC, obtain free surgical margins and desire of the patient. Follow up of the patients was filled in a form with demographic information, surgical, pathologic, adjuvant treatment and adverse events. RESULTS: As inclusion criteria, were selected to participate in this study 93 patients, mean age at diagnosis of 44.5 years (23-70 years). The mean follow-up was 62 months. The surgery was unilateral in 36 cases (38%) and bilateral in 57 cases (61%). of these, 14 patients (15%) underwent skin sparing mastectomy, 4 patients (5%) underwent bilateral different procedure (skin sparing mastectomy on one side and adenomastectomy on the other side); and most, 75 patients (80%), underwent a adeno-mastectomy. The immediate breast reconstruction was performed in all cases, using silicon prothesis in 72 (77%) and expanders in the others 21 patients (23%). Thirty one patients of our group were pTis. The others 62 patients (66%) presented with invasive lesions with an average tumor size of 2.3 cm (0.2 - 7.1 cm); Chemotherapy was neoadjuvant in 11 patients (17.7%) and adjuvant in 38 patients (61.2%). Hormone therapy was indicated in 52 cases (83.8%), 12 patients (19.3%) received anti-Her 2 therapy and radiotherapy was applied in 42 cases (67.7%). To evaluate the results of follow-up, 6 patients were excluded from analysis because the indication of the surgery was a recurrent tumor. So, 87 patients with a primary tumor at a mean follow up of 62 months were analised. In this period there were 5 (5.5%) local recurrences, 2 located in the NAC and 1 (1.1%) single distant metastase in the bone. All patients are alive. CONCLUSIONS: Skin-sparing mastectomy and adenomastectomy appears to be oncologically safe. In this study the overall recurrence rate is in keeping with previous studies. The role of postoperative radiotherapy to avoid local recurrence has to be defined in larger studies.