Purpose: Skin-sparing mastectomy (SSM) improves the quality of breast reconstruction, but SSM complications could potentially delay adjuvant therapies, adversely affecting cancer management. We assessed the relationship between SSM complications and tumor recurrence.

Methods: 70 patients (mean age 48.9 years, range 24-73; mean follow-up: 36.1 months) with and without SSM complications after reconstruction were compared using t-test and chi-square.

Results: SSM complications occurred in 15 patients (21.4%) and included mild (3), moderate (7), and extensive (5) skin loss, resulting in 5 re-operations but no failed reconstructions. Recurrence was significantly greater in patients with complications (4/15) than without complications (2/55) (p<0.05), but SSM complications did not delay adjuvant therapies (required in 8 of the 15 patients with SSM complications). No patients with prophylactic mastectomy (10), DCIS (14), or Stage 1 (16) developed local recurrence or metastatic disease. Diabetes, Stage 2/3, and BMI>30 were risk factors for SSM complications (p<0.05), but prior irradiation, smoking, and reconstruction type (TRAM n=27, latissimus n=25, expander n=18) were not.

Conclusions: While SSM complications did not delay the delivery of adjuvant therapies, SSM skin flap loss was associated with increased tumor recurrence. Patients with advanced clinical stage, diabetes, and elevated BMI are at increased risk for complications. Candidates for SSM need to be carefully selected to ensure successful reconstruction, while maintaining oncologic priorities.