Home 🡪 Case Studies 🡪 Breast Conserving Surgery In A Large Breast Tumour: Achieving Cosmetic Results Without Compromising Safety

Breast Conserving Surgery In A Large Breast Tumour: Achieving Cosmetic Results Without Compromising Safety

Brief history:

34 year old lady came to the OPD with complaints of lump in the right breast which had noticed incidentally. The core biopsy of the breast showed that it was a breast cancer. Further work up showed that the cancer had not spread to the nodes or any other distant organs. However the mammogram showed there was extensive microcalicification in the region surrounding the breast tumour. These microcalifications represent the possibility of precancerous changes in the surrounding tissues.

FIG 01. Mammogram showing microcalifications around breast tumor

Patient concerns:

Patient was a young woman who was working actively. Her main concern in the treatment was if it was possible to preserve her breast and only remove the lump.

Treatment challenges:

The microcalcifications that were observed on the mammogram next to the tumour in question meant there was a possibility of precancerous or early cancer there. Hence removing these areas of microcalifications was necessary along with the breast tumour. However such a removal would lead to a large defect which could not have been filled using local breast tissue. Hence the reconstruction of the defect required bringing in tissue from elsewhere.

Treatment offered:

Patient was advised to undergo breast conserving surgery i.e. excision of the entire upper outer quadrant to remove tumour and microcalcicfications with safe margins along with axiallry node dissection. The defect was planned to be filled with latissimus dorsi flap.

Results :

FIG 02. Significant Defect in the breast after removal of the tumor

FIG 03. Planning of Latissimus Dorsi Flap from the back

FIG 04. Flap ready for transfer to breast

FIG 05. Defect filled with flap

FIG 06. At the time of discharge (note the symmetry of breasts)

The procedure was uneventful. The flap adequately filled the defect. The recovery was uneventful. She was discharged after 6 days. She received adjuvant radiation which is necessary in breast conservation therapy along with chemotherapy. She is doing well and has returned to her routine life. She continues to be under regular follow up.

Core message:

Breast conservation is possible even in surgeries that lead to large defects. And acceptable cosmesis can be achieved using regional pedicled flaps. The conservation of breast preserves woman’s dignity, self-belief and the confidence to face the world