Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy

Background: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy. Methods: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). Results: In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p < 0.001). The overall 5-year risk for an LR was 3.8%. The risk was 3.1% for a margin greater than 2 mm and 11.2% for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23). Conclusions: For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.