Skin-Sparing Mastectomy With Sentinel Lymph Node Dissection

Stradling, Benjamin; Ahn, Mary S.; Angelats, Juan; Gabram, Sheryl G. A.

doi:10.1001/archsurg.136.9.1069

Cited by 28 publications

(18 citation statements)

References 18 publications

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“…These approaches often provide adequate access for sentinel lymph node biopsy (SLNB) and/or axillary node clearance (ANC) to be performed safely [5,11,16]. In larger breasts an additional axillary incision can be required, which is hidden from view, maintaining cosmesis [1].…”

Section: Surgical Considerationsmentioning

confidence: 99%

Oncological and aesthetic considerations of skin-sparing mastectomy

Patani

Mokbel

2007

Breast Cancer Res Treat

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Section: Surgical Considerationsmentioning

confidence: 99%

Oncological and aesthetic considerations of skin-sparing mastectomy

Patani

Mokbel

2007

Breast Cancer Res Treat

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“…1,3,5,6,8 A separate axillary incision may be made for sentinel or axillary lymphadenectomy if needed. 5,10,11 It became evident, during tumor board discussions at the John Wayne Cancer Institute, that the safety of SSM and the details of the procedure were not universally known or accepted. We became interested in determining the level of education and skepticism among those most likely to have an interest in this topic.…”

Section: Discussionmentioning

confidence: 99%

Skin‐sparing mastectomy

Bleicher

Hansen

Giuliano

2003

Cancer

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BACKGROUNDSkin‐sparing mastectomy (SSM) is a variation of modified radical mastectomy (MRM) optimized for reconstruction. The authors attempted to determine SSM attitudes and biases within different specialties and countries throughout the world.METHODSThe authors polled 11,485 individuals via e‐mail, including members of surgical, medical, and breast oncology societies, about SSM. Respondents were directed to a survey website where data were directly entered into a database.RESULTSAmong 1027 respondents, 19 said their knowledge was insufficient to attempt the survey. Surveys were completed by 1008 respondents (8.8%) from 52 countries, comprising 436 (43.3%) surgeons, 376 (37.3%) medical oncologists, 146 (14.5%) radiation oncologists, and 50 (5.0%) individuals from other fields. Of the respondents, 61.9% stated that SSMs are performed at their institution. However 19.1% of these believed that SSM leaves the nipple and areola intact. This perception was higher outside the U.S. (P < 0.0001). Despite knowledge by 77.8% that SSM does not have a higher local disease recurrence rate than MRM, 25.3% of these individuals did not believe the literature. This was most prevalent among radiation oncologists (48.5%), as was the belief that SSM is contraindicated in patients with ductal carcinoma in situ and invasive breast carcinoma (23.3%).CONCLUSIONSDespite a developing body of literature, there was variation in opinion among specialties and a lack of understanding of SSM. Many physicians were not familiar with the literature. Among those who were, skepticism was highest among radiation oncologists. Although these results were indicative of only those responding, education about SSM is needed across specialties and in other countries if the procedure is to be widely accepted. Cancer 2003. © 2003 American Cancer Society.

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“…Sentinel lymph node biopsy (SLNB) and/or axillary node clearance (ANC) can be performed safely through the same incision [6] [11] [15]. In larger breasts an additional axillary incision will sometimes be required [3].…”

Section: Surgical Considerationsmentioning

confidence: 99%

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Kasem¹,

Choy²,

Mokbel³

2014

JCT

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Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nippleareola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New techniques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

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Skin-Sparing Mastectomy With Sentinel Lymph Node Dissection

Cited by 28 publications

References 18 publications

Oncological and aesthetic considerations of skin-sparing mastectomy

Oncological and aesthetic considerations of skin-sparing mastectomy

Skin‐sparing mastectomy

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

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