Background: Breast conserving therapy (BCT), including breast conserving surgery (BCS) and radiotherapy has become the preferred method of treatment for early stage breast cancer. Guidelines for breast conserving surgery (BCS) advise mastectomy if negative margins cannot be obtained after reasonable surgical attempts. The surgical margin status after breast-conserving surgery is considered the strongest predictor for local failure. This study aimed to evaluate the value of repeating breast conservative surgery versus total mastectomy in patients with intrabreast tumour recurrence (IBTR) and to identify factors predictive of the need for multiple re-excisions.
Methods: Between 2004 and 2008, 58 patients underwent BCS for stages 0–II breast cancer [invasive duct carcinoma, n = 42; ductal carcinoma in situ (DCIS), n =16] presented with intrabreast tumour recurrence (IBTR) which was the only sign of relapse. 49 patients were considered suitable for further surgery, 9 were inoperable. Group A; Twenty patients (40.8%) were suitable for repeating conservative surgery especially when intra-operative margin assessment included gross tissue inspection with frozen section done and negative margins were achieved. While in group B; the other 29 patients (59.2%), total mastectomies were done. The median follow-up after second surgery was 28 months (range 6-48).
Results: The two years local recurrence rates for groups A, B were 10% and 3.5% respectively, where presented in group A as IBTR and in group B as chest wall recurrence. Women
Conclusion: Re-excision was not disadvantageous in selected patients and selection should include small solitary recurrences in a breast large enough to permit satisfactory cosmetic results. Re-excision doesn't impact on local recurrence rates if negative margins are ultimately obtained. The patient should be consented about the risk of further intrabreast tumor recurrence (IBTR).