When used in conjunction with appropriate multimodal therapy, total skin-sparing mastectomy (TSSM) is not associated with an increased risk for local recurrence, even in the setting of low pathological complete response (pCR) rates, according to a study of 139 patients with locally advanced breast cancer undergoing TSSM, including 25 with stage 2b disease and 114 with stage 3 disease. Researchers found:

•97% of patients received chemotherapy (77% neoadjuvant, 20% adjuvant).

•3% of patients received adjuvant hormonal therapy alone.

•12% of patients receiving neoadjuvant therapy had a pCR to therapy.

•During a mean follow-up of 41 months, 5% of patients had a local recurrence, 15.1% had a distant recurrence, and 2.2% had simultaneous local and distant recurrences.

•There were no local recurrences in the preserved nipple-areolar complex skin.

Citation: Peled AW, Wang F, Foster RD, et al. Expanding the indications for total skin-sparing mastectomy: is it safe for patients with locally advanced disease? [Published online ahead of print July 14, 2015]. Ann Surg Oncol.