Minimising Unnecessary Mastectomies in a Predominantly Chinese Community

Figure 1

((a)–(f)) Avoiding mastectomy in a patient with “multifocal tumour” on imaging. This 45-year-old patient was diagnosed with what was thought to be multifocal invasive ductal carcinoma at another facility following core biopsy. Mastectomy was originally recommended at the first centre due to the presence of multiple synchronous ipsilateral tumours and proximity of one lesion to the nipple. She sought a second opinion at the authors’ facility and was agreeable to a “trial of breast conservation treatment.” Localisation of the impalpable periareolar lesion and of the suspicious axillary lymph node was performed. She underwent an en bloc wide excision of the two left breast lesions through a boomerang incision and axillary staging through a separate axillary incision. The sentinel node coincided with the localised node and was found to be positive for metastasis on frozen section analysis. She underwent axillary dissection at the same operation. Histology was reported as a 4 cm invasive ductal carcinoma, with no intervening normal tissue between the clinical lesions. Three of sixteen axillary lymph nodes were involved. She is currently disease-free after more than 5 years.

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