Annals of Surgical Oncology

, Volume 23, Issue 1, pp 87–91 | Cite as

Expanding the Indications for Total Skin-Sparing Mastectomy: Is It Safe for Patients with Locally Advanced Disease?

  • Anne Warren Peled
  • Frederick Wang
  • Robert D. Foster
  • Michael Alvarado
  • Cheryl A. Ewing
  • Hani Sbitany
  • Laura J. Esserman
Breast Oncology



Indications for total skin-sparing mastectomy (TSSM) continue to expand. Although initially used only for early-stage breast cancer, TSSM currently is offered in many centers to patients with locally advanced disease. However, despite this practice change, limited data on oncologic outcomes in this population have been reported.


A retrospective review of a prospectively collected database of all patients undergoing TSSM and immediate reconstruction from 2005 to 2013 was performed. The outcomes for patients with stage 2b and stage 3 cancer were included in the analysis. The primary outcomes included the development of locoregional or distant recurrences.


Of 753 patients undergoing TSSM, 139 (18 %) presented with locally advanced disease. Of these 139 patients, 25 (18 %) had stage 2b disease, and 114 (82 %) had stage 3 disease. Most of the patients (97 %) received chemotherapy (77 % neoadjuvant, 20 % adjuvant), whereas 3 % received adjuvant hormonal therapy alone. Of the neoadjuvant patients, 13 (12 %) had a pathologic complete response (pCR) to treatment. During a mean follow-up period of 41 months (range 4–111 months), seven patients (5 %) had a local recurrence, 21 patients (15.1 %) had a distant recurrence, and three patients (2.2 %) had simultaneous local and distant recurrences. None of the local recurrences occurred in the preserved nipple–areolar complex skin.


Patients with locally advanced breast cancer are most at risk for distant rather than local recurrence, even after TSSM. When used in conjunction with appropriate multimodal therapy, TSSM is not associated with an increased risk for local recurrence in this population, even in the setting of low pCR rates.


Distant Recurrence Locoregional Recurrence Nipple Internal Mammary Node Transverse Rectus Abdominis Myocutaneous 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Anne Warren Peled
    • 1
    • 2
  • Frederick Wang
    • 2
  • Robert D. Foster
    • 2
  • Michael Alvarado
    • 1
  • Cheryl A. Ewing
    • 1
  • Hani Sbitany
    • 2
  • Laura J. Esserman
    • 1
  1. 1.Division of Breast Surgery, Department of Surgery, UCSF Carol Franc Buck Breast Care CenterUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA

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