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A ElSherif, S Armanyous, S Valente
Cleveland Clinic Foundation

Background: Salvage mastectomy is the recommended management for ipsilateral breast tumor recurrence (IBTR) after breast conservation surgery (BCS) and radiation. Studies have suggested that local control is similar between nipple sparing (NSM), skin sparing (SSM) and simple mastectomy (SM) as salvage options. The purpose of this study was to evaluate outcomes of the different types of mastectomy in regards to second cancer recurrence and surgical complications

Methods: An institutional retrospective review of patients who developed IBTR after BCS and received a salvage mastectomy from 2011-2019 was performed. Patient characteristics and treatment at initial cancer diagnosis and recurrence were collected. Type of mastectomy received as well as reconstruction were recorded. The incidence of second breast cancer recurrence as well as post-operative complications were compared between the three groups.

Results: A total of 113 salvage mastectomies were performed with a median age of 67 years at IBTR and median time to recurrence of 9 years. Overall, 17 patients received NSM, 48 SSM and 48 SM with 65% of patients receiving immediate reconstruction and 88% of those implant-based. The reconstruction group was more likely to be younger than the SM group (p value=0.0001). The SSM group had a higher BMI than the NSM group (p=0.04). A total of 86% of the cohort received radiation at the time of their initial cancer. Interestingly, although the reconstruction group was more likely to have received radiation at initial cancer diagnosis, there was no difference in the 90-day postoperative complications regardless of the type of mastectomy received.
At a median follow up of 2.7 years, none of NSM and SSM patients developed second breast cancer recurrence and 5 patients in the SM group experienced recurrence. After adjusting for patient and tumor characteristics between the 3 groups, MVA showed that tumor size at the time of recurrence was the only predictor of subsequent recurrence. (p=0.028) (Table 1)

Conclusion: NSM and SSM can be performed in patients presenting with IBTR with no compromise in oncological safety with low complication rates. Tumor size at recurrence is the only predictor to second recurrence regardless of the salvage mastectomy type.

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