Recurrence of a”notorious” breast disorder does NOT automatically mean an outright removal of the entire breast (total mastectomy) should always be done.
“Notorious” breast disorders means those having a track record of frequent recurrence after an operation. “Notorious” breast diseases include “benign phyllodes tumors” and, of course, breast cancers.
Below is an anecdotal report of EZ, from Quezon, a patient of mine since 2004. She was 46 years old in 2004 when she was afflicted with a benign phyllodes tumor on her right breast. I did a wide excision (removal of the tumor with a rim of normal surrounding tissue) [see lower incision scar in photo1]. Two years after, there was a recurrence on the same breast near the areolar edge. At that time, the options were a wide excision or a total mastectomy. EZ decided on a wide excision which I did [see upper incision scar, a little below the areola]. She is now 53 years old. I saw her today, August 6, 2011, with NO recurrence, 5 years after the second operation (the second wide excision) in 2006.
The common mindset and practice of physicians including breast specialists is to recommend or do total mastectomy after a recurrence.
This anecdote shows another wide excision can still be done for recurrence of a “notorious” breast disorder, even for a breast cancer that was previously managed by a wide excision [I will share anecdote on this in another blog].
Recurrence of a”notorious” breast disorder does NOT automatically mean an outright removal of the entire breast (total mastectomy) should always be done. Less than a total mastectomy for local control of the recurrence can be done if the following conditions are present:
- There is a single area of recurrence in the breast.
- The recurrence is well-defined and is confined to the breast proper, not involving the overlying skin and underlying chest muscles.
- The recurrence is of a size that if a wide excision (one that includes a rim of normal surrounding tissues) is done, there is- still a good amount of normal breast tissue that would be left behind that will maintain a good mound of the breast.
- The recurrence is of a size that if a wide excision is done, there will NOT be a severe distortion of the breast, a degree of distortion that is NOT acceptable to the patient and her significant other.
- An informed consent from the patient is obtained after the breast surgical oncologist explains the pros and cons of the options of wide excision and total mastectomy.
The size of the recurrence being referred to above is usually of a size that does NOT involve the whole breast and usually occupying 25% or less of the entire breast (see photo2).
If the size is more than 25% of the entire breast and involving practically the whole breast, a total mastectomy is the better option for a more effective local control of the recurrence (see photo 3).
Thus, be aware that recurrence of “notorious” breast disorder is NOT always a sentence for total breast removal!