Cunnick G H, Mokbel K
Wycombe General Hospital, Queen Alexandra Road, High Wycombe, Buckinghamshire, HP11 2TT, UK.
Int Semin Surg Oncol. 2006 May 25;3:14. doi: 10.1186/1477-7800-3-14.
To review evidence concerning the oncological safety of performing skin-sparing mastectomy (SSM) for invasive breast cancer and ductal carcinoma in situ (DCIS). Furthermore, the evidence concerning RT in relation to SSM and the possibility of nipple preservation was considered.
Literature review facilitated by Medline and PubMed databases.
Despite the lack of randomised controlled trials, SSM has become an accepted procedure in women undergoing mastectomy and immediate reconstruction for early breast cancer. Compared to non-skin-sparing mastectomy (NSSM), SSM seems to be oncologically safe in patients undergoing mastectomy for invasive tumours smaller than 5 cm, multicentric tumours, DCIS or risk-reduction. However, the technique should be avoided in patients with inflammatory breast cancer or in those with extensive tumour involvement of the skin in view of the high risk of local recurrence. SSM with nipple areola complex (NAC) preservation appears to be oncologically safe, provided the tumour is not close to the nipple and a frozen section protocol for the retro-areolar tissue is followed. Although radiotherapy (RT) does not represent a contraindication to SSM, the latter should be used with caution if postoperative RT is likely, since it detracts from the final cosmetic outcome.
回顾有关对浸润性乳腺癌和原位导管癌（DCIS）行保留皮肤乳房切除术（SSM）的肿瘤学安全性的证据。此外，还考虑了与SSM相关的放疗证据以及保留乳头的可能性。
通过Medline和PubMed数据库进行文献综述。
尽管缺乏随机对照试验，但SSM已成为早期乳腺癌行乳房切除术及即刻重建的女性所接受的术式。与非保留皮肤乳房切除术（NSSM）相比，对于肿瘤小于5 cm的浸润性肿瘤、多中心肿瘤、DCIS或出于降低风险目的而行乳房切除术的患者，SSM在肿瘤学上似乎是安全的。然而，鉴于局部复发风险高，炎性乳腺癌患者或皮肤有广泛肿瘤累及的患者应避免采用该技术。如果肿瘤不靠近乳头且遵循乳晕后组织冰冻切片方案，保留乳头乳晕复合体（NAC）的SSM在肿瘤学上似乎是安全的。虽然放疗（RT）并非SSM的禁忌证，但如果可能进行术后放疗，则应谨慎使用SSM，因为它会影响最终的美容效果。
