Our Summary

This research paper is about a type of breast cancer surgery called skin-sparing mastectomy (SSM), which aims to keep as much skin as possible to make breast reconstruction easier and improve the look of the breast after surgery. The researchers wanted to find out if this type of surgery is effective and safe for treating breast cancer.

They looked at a number of studies, including two prospective cohort studies and twelve retrospective cohort studies, involving over 12,000 surgeries. They found no randomized controlled trials or quasi-randomized controlled trials, which are considered to be more reliable types of studies.

They couldn’t draw any firm conclusions about whether SSM improves overall survival or reduces the risk of cancer coming back, because the studies were not consistent and did not provide enough data. They also found that the evidence was not clear on whether SSM reduces complications such as skin necrosis (skin death), infection, and bleeding.

The research did not provide data on other outcomes such as overall complications, the need for further surgery, and the quality of life of the patients after surgery. Only one study looked at the aesthetic outcome of SSM, and it found that most patients were satisfied with the look of their breasts after surgery.

In conclusion, the researchers say that there is not enough high-quality evidence to say for sure whether SSM is effective and safe for treating breast cancer. They suggest that the decision to use this type of surgery should be made on a case-by-case basis, considering the potential risks and benefits.

FAQs

  1. What is a skin-sparing mastectomy (SSM) and why is it performed?
  2. What conclusions were drawn from the research about the effectiveness and safety of SSM in treating breast cancer?
  3. Was there any information on the aesthetic outcome and patient satisfaction after undergoing a SSM?

Doctor’s Tip

One helpful tip a doctor might tell a patient about mastectomy is to carefully consider all options and discuss them with the healthcare team. It is important to weigh the potential benefits of skin-sparing mastectomy, such as improved cosmetic outcomes and easier reconstruction, against the potential risks and complications. Patients should also be aware that more research is needed to fully understand the long-term effectiveness and safety of this type of surgery. Ultimately, the decision should be based on individual circumstances and preferences.

Suitable For

Patients who are typically recommended mastectomy include those with:

  1. Early-stage breast cancer that is localized to the breast
  2. Large or multiple tumors in the breast
  3. Inflammatory breast cancer
  4. Genetic mutations such as BRCA1 or BRCA2 that increase the risk of developing breast cancer
  5. Previous radiation therapy to the breast
  6. Recurrence of breast cancer after lumpectomy or radiation therapy
  7. Patients who prefer mastectomy over lumpectomy for personal or psychological reasons

Overall, the decision to recommend mastectomy is based on the individual patient’s specific situation, including the size and location of the tumor, the stage of the cancer, the patient’s overall health, and their personal preferences. It is important for patients to discuss their options with their healthcare provider to make an informed decision about the most appropriate treatment plan for their breast cancer.

Timeline

Before mastectomy:

  1. Patient is diagnosed with breast cancer through imaging tests, biopsies, and other diagnostic procedures.
  2. Patient discusses treatment options with their healthcare provider, including the possibility of mastectomy.
  3. Patient undergoes preoperative testing and preparation for surgery.
  4. Patient may undergo neoadjuvant therapy (chemotherapy or hormone therapy) to shrink the tumor before surgery.
  5. Patient undergoes mastectomy surgery, which may involve removal of the breast tissue, lymph nodes, and sometimes the nipple and areola.

After mastectomy:

  1. Patient is monitored closely in the hospital for any postoperative complications.
  2. Patient may experience pain, swelling, and limited arm movement after surgery.
  3. Patient may choose to undergo breast reconstruction surgery immediately or at a later time.
  4. Patient receives follow-up care, including physical therapy, counseling, and regular check-ups to monitor for recurrence or complications.
  5. Patient may experience emotional and psychological challenges related to body image, self-esteem, and sexuality after mastectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about mastectomy include:

  1. What are the different types of mastectomy procedures available and which one is recommended for my specific situation?
  2. What are the potential risks and complications associated with mastectomy surgery?
  3. How will mastectomy affect my overall health and quality of life?
  4. Will I need additional treatments such as radiation or chemotherapy after mastectomy?
  5. What are the chances of the cancer coming back after mastectomy?
  6. What are the options for breast reconstruction after mastectomy and when can it be done?
  7. How will mastectomy impact my physical appearance and body image?
  8. What is the recovery process like after mastectomy and how long will it take?
  9. Are there any long-term side effects or complications to be aware of?
  10. How often will I need follow-up appointments and monitoring after mastectomy?

Reference

Authors: Mota BS, Bevilacqua JLB, Barrett J, Ricci MD, Munhoz AM, Filassi JR, Baracat EC, Riera R. Journal: Cochrane Database Syst Rev. 2023 Mar 27;3(3):CD010993. doi: 10.1002/14651858.CD010993.pub2. PMID: 36972145