Post mastectomy

This picture shows the typical appearance of filed change local recurrence following a Patey mastectomy for breast cancer. Local recurrence invariably occurs in the skin flaps adjacent to the scar. It has been suggested that it can occur as a result of either viable tumour cells remaining at the time of the original surgery or as a result of neoplastic change in residual breast tissue within the skin flaps. Local recurrence has been classified as single-spot, multiple-spot or field change with the treatment and prognosis differing for the different types. In half of all patients with local recurrence it is an isolated phenomenon but in the remainder it heralds systemic relapse. Restaging of all patients should occur following the detection of local recurrence.

For single-spot recurrence occurring many years after the original surgery, further local excision alone has been reported to provide good local control. A change of systemic therapy, possibly from tamoxifen to a progestogen or aromatase inhibitor or the addition of radiotherapy might also be considered. For multiple-spot recurrence in patients who have not previously received radiotherapy then this might be considered as an option. For wide spread field changes standard chemotherapy regimes are usually considered but disease control with these is often disappointing. Intraarterial chemotherapy is often effective in some patients. Failure to halt the progression of local recurrence can lead to cancer en-cuirase in which the chest wall becomes encircled with a tumour mass. This is a most unpleasant and debilitating condition for the patient. Symptoms may be improved with the use of topical metronidazole and charcoal impregnated dressings.

Recent papers

Blacklay P F, Campbell F S, Hinton S P et al. Patterns of flap recurrence following mastectomy. Br J Surg 1985; 72: 917-920.

Sundquist M, Thorstenson S, Lintenberg L, Brudin L, Nordenskjold B. Indicators of local recurrence in breast cancer. Eur J Surg Oncol 2000; 26: 357-362.