Minimising Unnecessary Mastectomies in a Predominantly Chinese Community

Figure 2

((a)–(h)) Avoiding mastectomy in a patient with “multicentric tumour” on imaging. This patient was diagnosed to have high grade ductal carcinoma in situ (DCIS) at an oncology centre and was offered mastectomy on the assumption that this was a multicentric lesion. She sought a second opinion with the authors and was agreeable to a “trial of breast conservation treatment.” Just prior to surgery, the lateral and medial extents of her dual-segment disease were localised under ultrasound guidance. Tissue resection was planned as indicated to balance the need for negative margins and retention of sufficient uninvolved parenchyma for defect repair. Through a radial incision and eccentric ellipse, an en bloc resection of the lesion using a multisegment resection pattern was performed. Sentinel node biopsy was performed through the same incision for this palpable high grade DCIS. Histology was reported as a unifocal 25 mm high grade DCIS. No multicentric component could be identified. She completed all adjuvant treatment and is now disease-free more than 5 years after surgery.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)