Aim: To review the oncological safety and aesthetic advantage of skin-sparing mastectomy (SSM) for invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS). Controversies including the impact of radiotherapy (RT) on immediate breast reconstruction (IBR), preservation of the nipple-areola complex (NAC) and the role of endoscopic mastectomy are also considered. Methods: Literature review using Medline and PubMed. Results: SSM is safe in selected cases; including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancers and tumours with extensive involvement of the skin represent contra-indications to SSM due to an unacceptable risk of local recurrence. SSM can facilitate IBR and is associated with an excellent aesthetic result. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM, however the cosmetic outcome may be adversely affected. Nipple/areola preservation is safe for peripherally located node negative tumours. A frozen section protocol for the retro-areolar tissue should be considered in these cases. The advent of acellular tissue matrix systems has widened the applicability of implant-based immediate reconstruction following SSM. Data on endoscopic mastectomy is limited and superiority over conventional SSM has not been demonstrated. Conclusion: SSM is safe in selected cases and is associated with advantages over simple mastectomy, including a superior aesthetic outcome and a potential reduction in the number of reconstructive procedures per patient.
B. Fisher, S. Anderson, J. Bryant, R. G. Margolese, M. Deutsch, E. R. Fisher, J. H. Jeong and N. Wolmark, “Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer,” New England Journal of Medicine, Vol. 347, 2002, pp. 1233-1241. doi:10.1056/NEJMoa022152
NICE guideline CG80, “Early and Locally Advanced Breast Cancer: Diagnosis and Treatment,” 2009. http://guidance.nice.org.uk/CG80/Guidance/pdf/English
D. A. Hidalgo, “Aesthetic Refinement in Breast Reconstruction: Complete Skin-Sparing Mastectomy with Autogenous Tissue Transfer,” Plastic & Reconstructive Surgery, Vol. 102, No. 1, 1998, pp. 63-70. doi:10.1097/00006534-199807000-00009
B. A. Toth and P. Lappert, “Modified Skin Incisions for Mastectomy: The Need for Plastic Surgical Input in Pre-Operative Planning,” Plastic & Reconstructive Surgery, Vol. 87, No. 6, 1991, pp. 1048-1053. doi:10.1097/00006534-199106000-00006
G. W. Carlson, “Skin Sparing Mastectomy: Anatomic and Technical Considerations,” American Surgeon, Vol. 62, No. 2, 1996, pp. 151-155.
R. M. Simmons and T. L. Adamovich, “Skin-Sparing Mastectomy,” Surgical Clinics of North America, Vol. 83, No. 4, 2003, pp. 885-899. doi:10.1016/S0039-6109(03)00035-5
S. E. Singletary, “Skin-Sparing Mastectomy with Immediate Breast Reconstruction: The M. D. Anderson Cancer Center Experience,” Annals of Surgical Oncology, Vol. 3, No. 4, 1996, pp. 411-416. doi:10.1007/BF02305673
G. W. Carlson, A. Losken, B. Moore, J. Thornton, M. Elliott, G. Bolitho and D. D. Denson, “Results of Immediate Breast Reconstruction after Skin-Sparing Mastectomy,” Annals of Plastic Surgery, Vol. 46, No. 3, 2001, pp. 222-228. doi:10.1097/00000637-200103000-00003
J. Shen, J. Ellenhorn, D. Qian, D. Kulber and J. Aronowitz, “Skin-Sparing Mastectomy: A Survey Based Approach to Defining Standard of Care,” American Surgeon, Vol. 74, No. 10, 2008, pp. 902-905.
R. K. Gendy, J. A. Able and R. M. Rainsbury, “Impact of Skin-Sparing Mastectomy with Immediate Reconstruction and Breast-Sparing Reconstruction with Miniflaps on the Outcomes of Oncoplastic Breast Surgery,” British Journal of Surgery, Vol. 90, No. 4, 2003, pp. 433-439. doi:10.1002/bjs.4060
S. Shrotria, “The Peri-Areolar Incision—Gateway to the Breast!” European Journal of Surgical Oncology, Vol. 27, No. 6, 2001, pp. 601-603. doi:10.1053/ejso.2001.1051
D. C. Hammond, P. A. Capraro, E. B. Ozolins and J. F. Arnold, “Use of a Skin-Sparing Reduction Pattern to Create a Combination Skin-Muscle Flap Pocket in Immediate Breast Reconstruction,” Plastic & Reconstructive Surgery, Vol. 110, No. 1, 2002, pp. 206-211. doi:10.1097/00006534-200207000-00035
S. E. Singletary and G. L. Robb, “Oncologic Safety of Skin-Sparing Mastectomy,” Annals of Surgical Oncology, Vol. 10, No. 2, 2003, pp. 95-97. doi:10.1245/ASO.2003.01.910
G. W. Carlson, J. Bostwick III, T. N. Styblo, B. Moore, J. T. Bried, D. R. Murray and W. C. Wood, “Skin Sparing Mastectomy, Oncologic and Reconstructive Considerations,” Annals of Surgery, Vol. 225, No. 5, 1997, pp. 570-575. doi:10.1097/00000658-199705000-00013
B. L. Stradling, M. Ahn, J. Angelats and S. G. Gabram, “Skin-Sparing Mastectomy with Sentinel Lymph Node Dissection: Less Is More,” Archives Surgery, Vol. 136, No. 9, 2001, pp. 1069-1075. doi:10.1001/archsurg.136.9.1069
T. J. Meretoja, T. A. Jahkola, T. S. Toivonen, L. A. Krogerus, P. S. Heikkila, K. A. von Smitten and M. H. Leidenius, “Sentinel Node Biopsy with Intraoperative Diagnosis in Patients Undergoing Skin-Sparing Mastectomy and Immediate Breast Reconstruction,” European Journal of Surgical Oncology, Vol. 33, No. 10, 2007, pp. 1146-1149.
H. M. Kuerer, S. Krishnamurthy and S. J. Kronowitz, “Important Technical Considerations for Skin-Sparing Mastectomy with Sentinel Lymph Node Dissection,” Archives of Surgery, Vol. 137, No. 6, 2002, p. 747. doi:10.1001/archsurg.137.6.747-a
P. Schrenk, S. Woelfl, S. Bogner, F. Moser and W. Wayand, “The Use of Sentinel Node Biopsy in Breast Cancer Patients Undergoing Skin Sparing Mastectomy and Immediate Autologous Reconstruction,” Plastic & Reconstructive Surgery, Vol. 116, No. 5, 2005, pp. 1278-1286. doi:10.1097/01.prs.0000181515.11529.9a
L. D. Friedlander, J. Sundin and N. Bakshandeh, “Endoscopy Mastectomy and Breast Reconstruction: Endoscopic Breast Surgery,” Aesthetic Plastic Surgery, Vol. 19, No. 1, 1995, pp. 27-29. doi:10.1007/BF00209307
K. Yamashita and K. Shimizu, “Endoscopic Video-Assisted Breast Surgery: Procedures and Short-Term Results,” Journal of Nippon Medical School, Vol. 73, No. 4, 2006, pp. 193-202. doi:10.1272/jnms.73.193
E. K. Lee, S. H. Kook, Y. L. Park and W. G. Bae, “Endoscopy-Assisted Breast-Conserving Surgery for Early Breast Cancer,” World Journal of Surgery, Vol. 30, No. 6, 2006, pp. 957-964. doi:10.1007/s00268-005-0202-y
Y. Tamaki, Y. Tsukamoto, Y. Miyoushi, T. Taguchi and S. Noguchi, “Overview: Video Assisted Breast Surgery,” Biomedicine & Pharmacotherapy, Vol. 56, Suppl. 1, 2002, pp. 187-191. doi:10.1016/S0753-3322(02)00206-8
H. Nakajima, K. Sakaguchi, N. Mizuta, T. Hachimine, S. Ohe and K. Sawai, “Video-Assisted Total Glandectomy and Immediate Reconstruction for Breast Cancer,” Biomedicine & Pharmacotherapy, Vol. 56, Suppl. 1, 2002, pp. 205-208.
W. S. Ho, S. Y. Ying and A. C. Chan, “Endoscopic-Assisted Subcutaneous Mastectomy and Axillary Dissection with Immediate Mammary Prosthesis Reconstruction for Early Breast Cancer,” Surgical Endoscopy and Other Interventional Techniques, Vol. 16, No. 2, 2002, pp. 302-306. doi:10.1007/s004640000203
K. Kitamura, M. Ishida, H. Inoue, J. Kinoshita, M. Hashizume and K. Sugimachi, “Early Results of an Endoscope-Assisted Subcutaneous Mastectomy and Reconstruction for Breast Cancer,” Surgery, Vol. 131, Suppl. 1, 2002, pp. 324-329. doi:10.1067/msy.2002.120120
S. S. Kroll, “Immediate Breast Reconstruction. A Review,” Annales Chirurgiae et Gynaecologiae, Vol. 86, No. 1, 1997, pp. 5-12.
J. W. Granzow, J. L. Levine, E. S. Chiu and R. J. Allen, “Breast Reconstruction Using Perforator Flaps,” Journal of Surgical Oncology, Vol. 94, No. 6, 2006, pp. 441-454. doi:10.1002/jso.20481
M Salgarello, A. Seccia and F. Eugenio, “Immediate Breast Reconstruction with Anatomical Permanent Expandable Implants after Skin-Sparing Mastectomy: Aesthetic and Technical Refinements,” Annals of Plastic Surgery, Vol. 52, No. 4, 2004, pp. 358-364. doi:10.1097/01.sap.0000105914.69611.c7
L. A. Woerdeman, J. J. Hage, M. M. Hofland and E. J. Rutgers, “A Prospective Assessment of Surgical Risk Factors in 400 Cases of Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Implants to Establish Selection Criteria,” Plastic and Reconstructive Surgery, Vol. 119, No. 2, 2007, pp. 455-463. doi:10.1097/01.prs.0000246379.99318.74
L. A. Woerdeman, J. J. Hage, M. J. Smeulders, E. J. Rutgers and C. M. van der Horst, “Skin-Sparing Mastectomy and Immediate Breast Reconstruction by Use of Implants: An Assessment of Risk Factors for Complications and Cancer Control in 120 Patients,” Plastic and Reconstructive Surgery, Vol. 118, No. 2, 2006, pp. 321-330. doi:10.1097/01.prs.0000234049.91710.ba
H. Sbitany, A. N. Amalfi and H. N. Langstein, “Preferences in Choosing between Breast Reconstruction Options: A Survey of Female Plastic Surgeons,” Plastic and Reconstructive Surgery, Vol. 124, No. 6, 2009, pp. 1781-1789. doi:10.1097/PRS.0b013e3181bf8056
M. Y. Nahabedian, “Postmastectomy Reconstruction: An Approach to Patient Selection,” Plastic and Reconstructive Surgery, Vol. 124, No. 1, 2009, pp. 43-52. doi:10.1097/PRS.0b013e31818b9005
W. J. Schneider, H. L. Hill and R. G. Brown, “Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction,” British Journal of Plastic Surgery, Vol. 30, No. 4, 1977, pp. 277-281. doi:10.1016/0007-1226(77)90117-5
J. I. de la Torre, R. J. Fix, P. M. Gardner and L. O. Vasconez, “Reconstruction with the Latissimus Dorsi Flap after Skin-Sparing Mastectomy,” Annals of Plastic Surgery, Vol. 46, No. 3, 2001, pp. 229-233. doi:10.1097/00000637-200103000-00004
C. R. Hartrampf, M. Scheflan and P. W. Black, “Breast Reconstruction with a Transverse Abdominal Island Flap,” Plastic and Reconstructive Surgery, Vol. 69, No. 2, 1982, pp. 216-225. doi:10.1097/00006534-198202000-00006
Z. M. Arnez, J. Bajec, A. F. Bardsley, T. Scamp and M. H. Webster, “Experience with 50 Free TRAM Flap Breast Reconstructions,” Plastic and Reconstructive Surgery, Vol. 87, No. 3, 1991, pp. 470-478. doi:10.1097/00006534-199103000-00014
M. Drucker-Zertuche and C. Robles-Vidal, “A 7 Year Experience with Immediate Breast Reconstruction after Skin Sparing Mastectomy for Cancer,” European Journal of Surgical Oncology, Vol. 33, No. 2, 2007, pp. 140-146. doi:10.1016/j.ejso.2006.10.010
G. Gherardini, R. Thomas, G. Basoccu, R. Zaccheddu, L. Fortunato, P. Cortino, G. R. Evans, A. Matarasso, M. D’Aiuto and G. D’Aiuto, “Immediate Breast Reconstruction with the Transverse Rectus Abdominis Musculocutaneous Flap after Skin-Sparing Mastectomy,” International Surgery, Vol. 86, No. 4, 2001, pp. 246-251.
H. Holmstrom, “The Free Abdominoplasty Flap and Its Use in Breast Reconstruction,” Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, Vol. 13, No. 3, 1979, pp. 423-427. doi:10.3109/02844317909013092
P. N. Blondeel, “The Sensate Free Superior Gluteal Artery Perforator (S-GAP) Flap: A Valuable Alternative in Autologous Breast Reconstruction,” British Journal of Plastic Surgery, Vol. 52, No. 3, 1999, pp. 185-193. doi:10.1054/bjps.1998.3032
K. Yano, K. Hosokawa, K. Nakai, T. Kubo, R. Hattori, T. Taguchi, Y. Tamaki and S. Noguchi, “Skin-Sparing Mastectomy and Immediate Reconstruction with a Deep Inferior Epigastric Perforator Flap,” Breast Cancer, Vol. 10, No. 3, 2003, pp. 275-280. doi:10.1007/BF02967663
A. M. Munhoz, E. Arruda, E. Montag, C. Aldrighi, J. M. Aldrighi, R. Gemperli and M. C. Ferreira, “Immediate Skin-Sparing Mastectomy Reconstruction with Deep Inferior Epigastric Perforator (DIEP) Flap. Technical Aspects and Outcome,” Breast Journal, Vol. 13. No. 5, 2007, pp. 470-478. doi:10.1111/j.1524-4741.2007.00467.x
V. F. Cocquyt, P. N. Blondeel, H. T. Depypere, K. A. Van De Sijpe, K. K. Daems, S. J. Monstrey and S. J. Van Belle, “Better Cosmetic Results and Comparable Quality of Life after Skin-Sparing Mastectomy and Immediate Autologous Breast Reconstruction Compared to Breast Conservative Treatment,” British Journal of Plastic Surgery, Vol. 56, No. 5, 2003, pp. 462-470. doi:10.1016/S0007-1226(03)00198-X
T. Fujino, T. Harasina and F. Aoyagi, “Reconstruction for Aplasia of the Breast and Pectoral Region by Microvascular Transfer of a Free Flap from the Buttock,” Plastic and Reconstructive Surgery, Vol. 56, No. 2, 1975, pp. 178-181. doi:10.1097/00006534-197508000-00010
R. J. Allen and C. Tucker Jr., “Superior Gluteal Artery Perforator Free Flap for Breast Reconstruction,” Plastic and Reconstructive Surgery, Vol. 95, No. 7, 1995, pp. 1207-1212. doi:10.1097/00006534-199506000-00010
A. B. Guerra, S. E. Metzinger, R. S. Bidros, P. S. Gill, C. L. Dupin and R. J. Allen, “Breast Reconstruction with Gluteal Artery Perforator (GAP) Flaps: A Critical Analysis of 142 Cases,” Annals of Plastic Surgery, Vol. 52, No. 2, 2004, pp. 118-125. doi:10.1097/01.sap.0000095437.43805.d1
Z. M. Arnez, D. Pogorelec, F. Planinsek and U. Ahcan, “Breast Reconstruction by the Free Transverse Gracilis (TUG) Flap,” British Journal of Plastic Surgery, Vol. 57, No. 1, 2004, pp. 20-26. doi:10.1016/j.bjps.2003.10.007
G. Wechselberger and T. Schoeller, “The Transverse Myocutaneous Gracilis Free Flap: A Valuable Tissue Source in Autologous Breast Reconstruction,” Plastic and Reconstructive Surgery, Vol. 114, No. 1, 2004, pp. 69-73. doi:10.1097/01.PRS.0000127797.62020.D4
A. G. Jimenez, P. St. Germain, M. Sirois, M. Hatheway and R. Lethbridge, “Free Omental Flap for Skin-Sparing Breast Reconstruction Harvested Laparoscopically,” Plastic and Reconstructive Surgery, Vol. 110, No. 2, 2002, pp. 545-551. doi:10.1097/00006534-200208000-00028
F. E. Barton Jr., J. M. English, W. B. Kingsley and M. Fietz, “Glandular Excision in Total Glandular Mastectomy and Modified Radical Mastectomy: A Comparison,” Plastic and Reconstructive Surgery, Vol. 88, No. 3, 1991, pp. 389-392. doi:10.1097/00006534-199109000-00001
R. Z. Torresan, C. C. dos Santos, H. Okamura and M. Alvarenga, “Evaluation of Residual Glandular Tissue after Skin-Sparing Mastectomies,” Annals of Surgical Oncology, Vol. 12, No. 12, 2005, pp. 1037-1044. doi:10.1245/ASO.2005.11.027
C. M. Ho, C. K. Mak, Y. Lau, W. Y. Cheung, M. C. Chan and W. K. Hung, “Skin Involvement in Invasive Breast Carcinoma: Safety of Skin-Sparing Mastectomy,” Annals of Surgical Oncology, Vol. 10, No. 2, 2003, pp. 102-107. doi:10.1245/ASO.2003.05.001
L. A. Newman, H. M. Kuerer, K. K. Hunt, S. S. Kroll, F. C. Ames, M. I. Ross, B. W. Feig and S. E. Singletary, “Presentation, Treatment, and Outcome of Local Recurrence after Skin-Sparing Mastectomy and Immediate Breast Reconstruction,” Annals of Surgical Oncology, Vol. 5, No. 7, 1998, pp. 620-626. doi:10.1007/BF02303832
S. Lanitis, P. P. Tekkis, G. Sgourakis, N. Dimopoulos, R. Al Mufti and D. J. Hadjiminas, “Comparison of Skin-Sparing Mastectomy versus Non-Skin-Sparing Mastectomy for Breast Cancer: A Meta-Analysis of Observational Studies,” Annals of Surgery, Vol. 251, No. 4, 2010, pp. 632-639. doi:10.1097/SLA.0b013e3181d35bf8
M. Yi, S. J. Kronowitz, F. Meric-Bernstam, B. W. Feig, W. F. Symmans, A. Lucci, M. I. Ross, G. V. Babiera, H. M. Kuerer and K. K. Hunt, “Local, Regional, and Systemic Recurrence Rates in Patients Undergoing Skin-Sparing Mastectomy Compared with Conventional Mastectomy,” Cancer, Vol. 117, No. 5, 2011, pp. 916-924. doi:10.1002/cncr.25505
K. J. Downes, B. S. Glatt, S. K. Kanchwala, R. Mick, D. L. Fraker, K. R. Fox, L. J. Solin, L. P. Bucky and B. J. Czerniecki, “Skin-Sparing Mastectomy and Immediate Reconstruction Is an Acceptable Treatment Option for Patients with High-Risk Breast Carcinoma,” Cancer, Vol. 103, No. 5, 2005, pp. 906-913. doi:10.1002/cncr.20851
R. D. Foster, L. J. Esserman, J. P. Anthony, E. S. Hwang and H. Do, “Skin-Sparing Mastectomy and Immediate Breast Reconstruction: A Prospective Cohort Study for the Treatment of Advanced Stages of Breast Carcinoma,” Annals of Surgical Oncology, Vol. 9, No. 5, 2002, pp. 462-466. doi:10.1007/BF02557269
T. M. Allweis, M. E. Boisvert, S. E. Otero, et al., “Immediate Reconstruction after Mastectomy for Breast Cancer Does Not Prolong the Time to Starting Adjuvant Chemotherapy,” American Journal of Surgery, Vol. 183, 2002, 218-21. doi:10.1016/S0002-9610(02)00793-6
R. M. Rainsbury, “Skin-Sparing Mastectomy,” British Journal of Surgery, Vol. 93, No. 3, 2006, pp. 276-281. doi:10.1002/bjs.5257
H. N. Langstein, M. H. Cheng, S. E. Singletary, G. L. Robb, E. Hoy, T. L. Smith and S. S. Kroll, “Breast Cancer Recurrence after Immediate Reconstruction: Patterns and Significances,” Plastic and Reconstructive Surgery, Vol. 111, No. 2, 2003, pp. 712-720. doi:10.1097/01.PRS.00000 41441.42563.95
G. W. Carlson, A. Page, E. Johnson, K. Nicholson, T. M. Styblo and W. C. Wood, “Local Recurrence of Ductal Carcinoma in Situ after Skin-Sparing Mastectomy,” Journal of the American College of Surgeons, Vol. 204, No. 5, 2007, pp. 1074-1078. doi:10.1016/j.jamcollsurg.2007.01.063
K. Mokbel, “Towards Optimal Management of Ductal Carcinoma in Situ of the Breast,” European Journal of Surgical Oncology, Vol. 29, No. 2, 2003, pp. 191-197. doi:10.1053/ejso.2002.1425
R. Mokbel and K. Mokbel, “Skin-Sparing Mastectomy and Radiotherapy: An Update,” International Seminars in Surgical Oncology, Vol. 17, 2006, pp. 3-35.
I. T. Rubio, N. Mirza, A. A. Sahin, G. Whitman, S. S. Kroll, F. C. Ames and S. E. Singletary, “Role of Specimen Radiography in Patients Treated with Skin-Sparing Mastectomy for Ductal Carcinoma in Situ of the Breast,” Annals of Surgical Oncology, Vol. 7, No. 7, 2000, pp. 544-548. doi:10.1007/s10434-000-0544-5
A. J. Spiegel and C. E. Butler, “Recurrence Following Treatment of Ductal Carcinoma in Situ with Skin-Sparing Mastectomy and Immediate Breast Reconstruction,” Plastic and Reconstructive Surgery, Vol. 111, No. 2, 2003, pp. 706-711. doi:10.1097/01.PRS.0000041440.12442.05
C. Laronga, B. Kemp, D. Johnston, G. L. Robb and S. E. Singletary, “The Incidence of Occult Nipple-Areola Complex Involvement in Breast Cancer Patients Receiving a Skin-Sparing Mastectomy,” Annals of Surgical Oncology, Vol. 6, No. 6, 1999, pp. 609-613. doi:10.1007/s10434-999-0609-z
J. S. Vaidya, “Prediction of Nipple and Areola Involvement in Breast Cancer,” European Journal of Surgical Oncology, Vol. 24, No. 1, 1998, pp. 15-16. doi:10.1016/S0748-7983(98)80117-0
R. M. Simmons, M. Brennan, P. Christos, V. King and M. Osborne, “Analysis of Nipple/Areolar Involvement with Mastectomy: Can the Areola Be Preserved?” Annals of Surgical Oncology, Vol. 9, No. 2, 2002, pp. 165-168. doi:10.1007/BF02557369
B. Gerber, A. Krause, T. Reimer, H. Muller, I. Kuchenmeister, J. Makovitzky, G. Kundt and K. Friese, “Skin-Sparing Mastectomy with Conservation of the Nipple-Areola Complex and Autologous Reconstruction Is an Oncologically Safe Procedure,” Annals of Surgery, Vol. 238, No. 1, 2003, pp. 120-127. doi:10.1097/00000658-200307000-00016
A. Banerjee, S. Gupta and N. Bhattacharya, “Preservation of Nipple-Areola Complex in Breast Cancer—A Clinicopathological Assessment,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 61, No. 10, 2007, pp. 1195-1198.
A. K. Schecter, M. B. Freeman, D. Giri, E. Sabo and J. Weinzweig, “Applicability of the Nipple-Areola Complex-Sparing Mastectomy: A Prediction Model Using Mammography to Estimate Risk of Nipple-Areola Complex Involvement in Breast Cancer Patients,” Annals of Plastic Surgery, Vol. 56, No. 5, 2006, pp. 498-504. doi:10.1097/01.sap.0000216946.83252.e4
Z. Vlajcic, R. Zic, S. Stanec, S. Lambasa, M. Petrovecki and Z. Stanec, “Nipple-Areola Complex Preservation: Predictive Factors of Neoplastic Nipple-Areola Complex Invasion,” Annals of Plastic Surgery, Vol. 55, No. 3, 2005, pp. 240-244. doi:10.1097/01.sap.0000171680.49971.85
C. M. Chen, J. J. Disa, V. Sacchini, A. L. Pusic, B. J. Mehrara, C. A. Garcia-Etienne and P. G. Cordeiro, “Nipple-Sparing Mastectomy and Immediate Tissue Expander/Implant Breast Reconstruction,” Plastic and Reconstructive Surgery, Vol. 124, No. 6, 2009, pp. 1772-1780. doi:10.1097/PRS.0b013 e3181bd05fd
C. N. Verheyden, “Nipple-Sparing Total Mastectomy of Large Breasts: The Role of Tissue Expansion,” Plastic and Reconstructive Surgery, Vol. 101, No. 6, 1998, pp. 1494-1500. doi:10.1097/00006534-199805000-00010
A. L. Komorowski, V. Zanini, L. Regolo, A. Carolei, W. M. Wysocki and A. Costa, “Necrotic Complications after Nipple- and Areola-Sparing Mastectomy,” World Journal of Surgery, Vol. 30, No. 8, 2006, pp. 1410-1413. doi:10.1007/s00268-005-0650-4
J. P. Crowe Jr., J. A. Kim, R. Yetman, J. Banbury, R. J. Patrick and D. Baynes, “Nipple-Sparing Mastectomy: Technique and Results of 54 Procedures,” Archives of Surgery, Vol. 139, No. 2, 2004, pp. 148-150. doi:10.1001/archsurg.139.2.148
P. Mustonen, J. Lepisto, A. Papp, M. Berg, T. Pietilainen, V. Kataja and M. Harma, “The Surgical and Oncological Safety of Immediate Breast Reconstruction,” European Journal of Surgical Oncology, Vol. 30, No. 8, 2004, pp. 817-823. doi:10.1016/S0748-7983(04)00143-X
L. Regolo, B. Ballardini, E. Gallarotti, E. Scoccia and V. Zanini, “Nipple Sparing Mastectomy: An Innovative Skin Incision for an Alternative Approach,” Breast, Vol. 17, No. 1, 2007, pp. 8-11.
J. Y. Petit, U. Veronesi, R. Orecchia, A. Luini, P. Rey, M. Intra, F. Didier, S. Martella, M. Rietjens, C. Garusi, F. DeLorenzi, G. Gatti, M. E. Leon and C. Casadio, “Nipple-Sparing Mastectomy in Association with Intra Operative Radiotherapy (ELIOT): A New Type of Mastectomy for Breast Cancer Treatment,” Breast Cancer Research and Treatment, Vol. 96, No. 1, 2006, pp. 47-51. doi:10.1007/s10549-005-9033-7
G. Bistoni, A. Rulli, L. Izzo, G. Noya, C. Alfano and F. Barberini, “Nipple-Sparing Mastectomy. Preliminary Results,” Journal of Experimental & Clinical Cancer Research, Vol. 25, No. 4, 2006, pp. 495-497.
R. M. Simmons, S. T. Hollenbeck and G. S. Latrenta, “Two-Year Follow-Up of Areola-Sparing Mastectomy with Immediate Reconstruction,” American Journal of Surgery, Vol. 188, No. 4, 2004, pp. 403-406. doi:10.1016/j.amjsurg.2004.07.001
A. Recht and S. B. Edge, “Evidence-Based Indications for Postmastectomy Irradiation,” Surgical Clinics of North America, Vol. 83, No. 4, 2003, pp. 995-1013. doi:10.1016/S0039-6109(03)00033-1
M. Overgaard, H. M. Nielsen and J. Overgaard, “Is the Benefit of Postmastectomy Irradiation Limited to Patients with Four or More Positive Nodes, as Recommended in International Consensus Reports? A Subgroup Analysis of the DBCG 82 b & c Randomized Trials,” Radiotherapy & Oncology, Vol. 82, No. 3, 2007, pp. 247-253. doi:10.1016/j.radonc.2007.02.001
I. H. Kunkler, P. Canney, G. van Tienhoven and N. S. Russell, “Elucidating the Role of Chest Wall Irradiation in ‘Intermediate-Risk’ Breast Cancer: The MRC/EORTC SUPREMO Trial,” Clinical Oncology, Vol. 20, No. 1, 2008, pp. 31-34. doi:10.1016/j.clon.2007.10.004
M. Hussien, B. Salah, A. Malyon and E. M. Wieler-Mithoff, “The Effect of Radiotherapy on the Use of Immediate Breast Reconstruction,” European Journal of Surgical Oncology, Vol. 30, No. 5, 2004, pp. 490-494. doi:10.1016/j.ejso.2004.03.005
T. A. Buchholz, S. J. Kronowitz and H. M. Kuerer, “Immediate Breast Reconstruction after Skin-Sparing Mastectomy for the Treatment of Advanced Breast Cancer: Radiation Oncology Considerations,” Annals of Surgical Oncology, Vol. 9, No. 8, 2002, pp. 820-821. doi:10.1007/BF02574506
S. J. Kronowitz and G. L. Robb, “Breast Reconstruction with Postmastectomy Radiation Therapy: Current Issues,” Plastic and Reconstructive Surgery, Vol. 114, No. 4, 2004, pp. 950-960. doi:10.1097/01.PRS.0000133200.99826.7F
K. K. Hunt, B. J. Baldwin, E. A. Strom, F. C. Ames, M. D. McNeese, S. S. Kroll and S. E. Singletary, “Feasibility of Postmastectomy Radiation Therapy after TRAM Flap Breast Reconstruction,” Annals of Surgical Oncology, Vol. 4, No. 5, 1997, pp. 377-384. doi:10.1007/BF02305549
N. V. Tran, G. R. Evans, S. S. Kroll, B. J. Baldwin, M. J. Miller, G. P. Reece and G. L. Robb, “Postoperative Adjuvant Irradiation: Effects on Tranverse Rectus Abdominis Muscle Flap Breast Reconstruction,” Plastic and Reconstructive Surgery, Vol. 106, No. 2, 2000, pp. 313-317. doi:10.1097/00006534-200008000-00011
G. R. Evans, M. A. Schusterman and S. S. Kroll, “Reconstruction and the Radiated Breast: Is There a Role for Implants?” Plastic and Reconstructive Surgery, Vol. 96, No. 5, 1995, pp. 1111-1115. doi:10.1097/00006534-199510000-00016
P. G. Cordeiro, A. L. Pusic, J. J. Disa, B. McCormick and K. VanZee, “Irradiation after Immediate Tissue Expander/Implant Breast Reconstruction: Outcomes, Complications, Aesthetic Results, and Satisfaction among 156 Patients,” Plastic and Reconstructive Surgery, Vol. 113, No. 3, 2004, pp. 877-881. doi:10.1097/01.PRS.0000105689.84930.E5
A. Araco, R. Caruso, F. Araco, J. Overton and G. Gravante, “Capsular Contractures: A Systematic Review,” Plastic and Reconstructive Surgery, Vol. 124, No. 6, 2009, pp. 1808-1819. doi:10.1097/PRS.0b013e3181bf7f26
C. S. Hultman and S. Daiza, “Skin-Sparing Mastectomy Flap Complications after Breast Reconstruction: Review of Incidence, Management, and Outcome,” Annals of Plastic Surgery, Vol. 50, No. 3, 2003, pp. 249-255. doi:10.1097/01.SAP.0000046784.70583.E1
E. I. Chang, D. P. Ly and P. D. Wey, “Comparison of Aesthetic Breast Reconstruction after Skin-Sparing or Conventional Mastectomy in Patients Receiving Preoperative Radiation Therapy,” Annals of Plastic Surgery, Vol. 59, No. 1, 2007, pp. 78-81. doi:10.1097/01.sap.0000252487.27077.d6