Management of skin-sparing mastectomy: Results of a survey of German Hospitals

Background: The aim of this study was to evaluate the current
management of skin-sparing mastectomy in German hospitals and to
determine its oncologic safety. For this purpose, 100 surgeons were
surveyed regarding their use of skin-sparing mastectomy. Results:
Almost all surveyed hospitals performed skin-sparing mastectomy.
Most of them believe that the recurrence rate is equal to that of
conventional mastectomy. 95% regard inflammatory cancer as a
contraindication to skin-sparing surgery. Most of the hospitals
thin out the skin without leaving any macroscopic glandular tissue
behind, and 73% leave the nipple-areola complex (NAC) on the basis
of frozen sections. Volume replacement is most commonly done with
latissimus dorsi muscle flaps and pedicled TRAM flaps. In 76% of
the surveyed hospitals, reconstruction after mastectomy is
performed by the gynecological department. Conclusion: Skin-sparing
mastectomy is considered to be the best cosmetic option for breast
reconstruction in selected breast cancer patients. At present,
statistical proof of its oncologic safety is lacking. The surgical
techniques used for skin-sparing mastectomy have not yet been
standardized. In order to achieve standardization, careful
discussion-making and evaluation remain important.