Is Surgery for Locally Advanced Breast Cancer Possible? A Multidisciplinary Approach
Leticia Pérez Santiago1*, Marcos Adrianzén Vargas1, Elvira Buch Villa1, Genaro Galán Gil2, Gemma Bellver Lobato1, Jose Manuel Marquez Cañada3, Fiorella Adrianzén Álvarez1 and Joaquín Ortega Serrano1
1Breast Unit Surgery, Department of General Surgery, Hospital Clínico Universitario, Spain
2Department of Thoracic Surgery, Hospital Clínico Universitario, Spain
3Department of Plastic and Reconstructive Surgery, Hospital Clínico Universitario, Spain
Submission: August 16, 2019; Published: August 29, 2019
*Corresponding author: Leticia Pérez Santiago, Department of Surgery, Hospital Clínico Universitario, Avenida Blasco Ibañez Nº 17. 46010, Valencia, Spain
How to cite this article: Leticia P S, Marcos A V, Elvira B V, Genaro G G, Gemma B L et all. Is Surgery for Locally Advanced Breast Cancer Possible? A
Multidisciplinary Approach. Open Access J Surg. 2019; 11(1): 555802. DOI: DOI:10.19080/OAJS.2019.10.555802.
Locally advanced breast cancer has a low incidence and the first line treatment is chemotherapy and radiotherapy. Herein, we present a case report of a 61 years-old woman with a diagnostic of locally advanced breast cancer without response to treatment. Due to the pain and the decreased of quality of life, we decide to perform a multidisciplinary surgery with excellent results. We suggest that a multidisciplinary surgical resection can be the solution when there is a lack of response to the chemotherapy and the patient refers pain and deterioration.
A 61-year-old woman with a diagnostic of locally advanced breast cancer affecting skin, rib cage and sternum was derivate to our Breast Surgery Unit to assess surgical treatment. A mass of hard consistency with skin retraction and ulceration was palpated during medical examination (Figure 1A). A diagnosis of an extensive density asymmetry, retraction with a thickened
nipple areola complex (NAC) and ipsilateral skin thickening with a multinodular mammary mass wrapping the pectoral and intercostal musculature and multiple adenopathies were shown in the complementary imaging tests (Figures 1B and 1C).The patient referred pain and decreased of quality of life and due to the skin ulceration and the lack of chemotherapeutic response.
We planned to perform a block resection with a
multidisciplinary surgical team. The surgical procedure was
performed under general anaesthesia with the patient in
supine position with her left arm extended. The mastectomy
incision was mapped out preoperatively, with the patient
in the upright position (Figure 2A). We performed a radical
mastectomy leaving the deep plane attached to the costal wall.
Next, a block resection including the breast, axillary lymph
nodes and fourth and fifth costal arch within the pectoralis
major and intercostal musculature, was made in collaboration
with the Thoracic surgeon (Figure 2B). A thoracic drainage was
placed. The thoracic wall reconstruction was carried out with a
polytetrafluoroethylene mesh set with a monofilament suture
and covered with a latissimus dorsi flap made by the Plastic
Surgeon (Figure 2C).
The patient’s postoperative course was uneventful. She
was discharged on the seventh postoperative day. The wound
was followed up for several weeks until satisfactory healing
was observed (Figure 2D). Pathologic evaluation confirmed
an infiltrating carcinoma (lobular infiltrative pattern) with
metastases in 1 of the 17 axillary lymph nodes. Pectoralis major
and intercostal musculature were affected, and the sternal edge
was free of neoplastic infiltration.
Locally advanced breast cancer has a low incidence (4-6%)
and the first line treatment is chemotherapy and radiotherapy
[1,2]. However, when there is a lack of response to the
chemotherapy and the patient refers pain and deterioration,
a multidisciplinary surgical resection can be the solution .
The main objectives of the resection are ensuring complete
resection of the tumor to get free microscopic margins of
the lesion, and to achieve the primary closure of the thoracic
cavity and skin if necessary. With this case report, we suggest
that a multidisciplinary surgical approach facilitates complete
resections with curative intent favoring the quality of life of
We declare that this manuscript is original, has not been
published before and is not currently being considered for
publication elsewhere. We know of no conflicts of interest
associated with this publication, and there has no significant
financial support for this work that could influenced its outcome.