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Invited Critique |

Optimizing the Total Skin-Sparing Mastectomy—Invited Critique

Leigh Neumayer, MD, MS
Arch Surg. 2008;143(1):45. doi:10.1001/archsurg.2007.14.
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Wijayanayagam and colleagues describe their evolving experience with TSSM. This work adds to a growing literature confirming the feasibility of TSSM for both prophylaxis and therapy.14 In addition to the reported results, several issues raised by this article deserve comment.

First, the authors emphasize the need for documentation of no tumor near (defined as 2 cm by these authors and others) the NAC. In this series from San Francisco, MRI was used to estimate this preoperatively, with confirmation at final pathologic analysis. Others have recommended intraoperative frozen-section analysis, but the gold standard is the final pathologic findings.3 If this is the case and if returning the patient to the operating room to resect the NAC is of little consequence, perhaps it would be more cost-effective in most practice settings to rely primarily on the final pathologic findings.

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mastectomy

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