Recurrence and Survival Analysis in Skin-Sparing Mastectomy with Immediate Reconstruction Compared with Conventional Mastectomy

Park, Eun Hwa; Kim, Ji Hun; Son, Byung Ho; Kwak, Beom Seok; Kim, Jung Kyung; Kim, Hee Jung; Lee, Jung Sun; Hong, Soo Jung; Lee, Taek Jong; Um, Jin Sup; Ahn, Sei Hyun

Abstract

PURPOSE
A skin-sparing mastectomy (SSM), followed by immediate reconstruction, which has aesthetic advantages, is being increasingly used to treat many early breast carcinomas; however, there are few data regarding the outcome and safety of this procedure. The objective of this study was to evaluate the safety of utilizing a SSM with immediate reconstruction compared with the outcome of a conventional mastectomy. METHODS: A retrospective review was performed on 169 patients who underwent a SSM with immediate reconstruction, and 2102 patients who received a conventional mastectomy between January 1996 and December 2002, at the Asan Medical Center. The patient and tumor characteristics, as well as the types of reconstruction, incidences of recurrence and survival rates were examined. RESULTS: The mean age of the SSM group was younger (39 vs. 47 years, p < 0.001), and the mean tumor size smaller than those of the mastectomy group (2.6 vs. 3.2cm, p = 0.002). Lymph node involvement was present in 39.6% and 48.4% of the SSM and mastectomy groups, respectively (p = 0.24). The proportion at early stages (0 and 1) in the SSM group was higher than those in the mastectomy group (50.9 vs. 30.7%, p < 0.001). In the high-risk patients, postoperative radiation was administered to 24.1 and 54.9% of the SSM and mastectomy group, respectively (p = 0.002). With a median follow-up of 41 months, the recurrence rates for the SSM and mastectomy groups were 11.8 (20 of 169 patients) and 14.4% (303 of 2102 patients), respectively (p = 0.22). There were no differences in the locoregional and distant recurrences between the two groups. The 5-year disease free survivals for the SSM and mastectomy groups were 81.9 and 81.7%, respectively (p = 0.71). The 5-year overall survivals for the SSM and mastectomy groups were 91.7 and 88,8%, respectively (p = 0.13). In a univariate analysis, the factors associated with a recurrence and the survival rates were the tumor stage and a lymph node positive state. CONCLUSION: No significant differences were found in the recurrence and survival rates of the SSM group, with immediate reconstruction, compared to those of the mastectomy only group. A skin-sparing mastectomy, with immediate reconstruction, which has greater aesthetic benefits, appeared to be an oncologically safe treatment option for breast carcinomas.