Background: Skin-sparing mastectomy (SSM) followed by immediate reconstruction has been proven to be an oncologically safe and effective treatment option for patients with early stage (T1 or T2) breast carcinoma. However, no large, long-term studies exist which evaluate the efficacy of SSM and immediate reconstruction in patients with high-risk breast cancers (stage IIb or greater). Delayed reconstruction remains the conventional treatment option for patients with locally advanced disease. We present our significant experience with the use of skin sparing mastectomy and immediate reconstruction in patients with high-risk breast cancers.

Methods: A series of 119 consecutive patients with invasive breast carcinoma who underwent SSM and immediate reconstruction (from July, 1996 to June, 2001) were prospectively observed. Patients were considered to have high-risk tumors due to the presence of the following criteria: 4 or more positive nodes, tumors greater than 4 cm, or tumor stage IIB or higher. These high-risk patients (42 tumors in 40 patients) were compared to patients with locally advanced disease treated with delayed reconstruction. Tumor characteristics, type of reconstruction, margin status, adjuvant therapy, post-operative complications, incidence of local and systemic recurrence and distant metastases were noted.

Results: High-risk patients (stage IIA, n = 6; stage IIB, n = 26; stage IIIA, n = 7; stage IIIB, n = 3) were reconstructed immediately with the use of a transverse rectus abdominis myocutaneous flap (n = 30), a latissimus dorsi myocutaneous flap plus an implant (n = 3), or tissue expanders with subsequent implant placement (n = 9). The median length of follow-up in this group of patients was 40.5 months (range, 18.1-77.4 months). Immediate reconstruction did not significantly delay post-operative adjuvant therapy (mean interval of 38 days, range 22-238 days). Local recurrence was found to occur in two patients (4.8%), systemic recurrence in three (7.1%), and both local and distant recurrence in four others (9.6%).

Conclusions: SSM with immediate reconstruction is an oncollogically safe and effective means of treatment for high-risk patients with advanced stages of breast carcinoma who do not have involvement of overlying breast skin. In addition to the aesthetic and psychological benefits of SSM with immediate reconstruction, local recurrence rates and the incidence of distant metastases are not increased when compared with low-risk patients treated in the same fashion. Furthermore, we noted that recurrence rates were similar when compared to historical controls of high-risk patients treated by delayed reconstruction. Furthermore, postoperative adjuvant therapy was not delayed in these patients.