Skin-sparing
mastectomy with immediate
breast reconstruction can provide an excellent cosmetic result. Despite its increasing popularity, few studies have assessed the risk of recurrence when the procedure is used for the treatment of
ductal carcinoma in situ. To evaluate the oncologic safety of skin-sparing
mastectomy used for the treatment of
ductal carcinoma in situ, the recurrence rate was analyzed. Patients with
ductal carcinoma in situ or invasive
carcinoma or both who underwent skin-sparing
mastectomy with immediate
breast reconstruction between 1985 and 1994 and had a follow-up period of at least 6 years were included in this retrospective analysis. The recurrence rates were determined for invasive
carcinoma (with or without foci of
ductal carcinoma in situ) and
ductal carcinoma in situ alone. A total of 221 patients were included, 177 patients with invasive
carcinoma and 44 patients with
ductal carcinoma in situ alone. The immediate
breast reconstructions were performed with transverse rectus abdominis muscle (TRAM) flaps in 62 percent of patients, implants in 34 percent of patients, and latissimus dorsi
myocutaneous flaps (with or without implants) in 4 percent of patients. The local recurrence rate was zero of 44 for patients with
ductal carcinoma in situ and 5.6 percent (10 of 177) for patients with invasive
carcinoma during a mean follow-up period of 9.8 years. There was a 6.8 percent (12 of 177) metastatic recurrence rate in the invasive
carcinoma group. All recurrences were invasive
ductal carcinoma. Of the patients with
ductal carcinoma in situ alone, none developed metastatic disease. The combined metastatic and local recurrence rates for the invasive
carcinoma group (n = 177) with each type of reconstruction were 13 percent (14 of 110), 12 percent (seven of 60), and 14 percent (one of seven) for TRAM flaps, implants, and latissimus dorsi flaps, respectively. The risk of recurrence following skin-sparing
mastectomy and immediate
breast reconstruction for
ductal carcinoma in situ is low during this follow-up period. Therefore, skin-sparing
mastectomy with immediate
breast reconstruction seems to be a safe oncologic treatment option for
ductal carcinoma in situ; however, a longer follow-up period is important to determine the long-term risk of recurrence.