THE SURGICAL MANAGEMENT OF CENTRAL BREAST TUMOURS AT A SPECIALIST BREAST UNIT IN JOHANNESBURG, SOUTH AFRICA.

BACKGROUND: Central breast tumours are defined as tumours in the retroareolar area, or within 1.5-2.0 cm from the areolar edge. In the past, breast conservation therapy (BCT) for central breast tumours was considered controversial due to concerns regarding oncologic safety and cosmesis. Recent evidence does however suggest that oncoplastic techniques offer a cosmetically acceptable and safe alternative to mastectomy in these tumours.

METHOD: Patients with central breast tumours (invasive and in situ) were identified from a breast cancer database of 431 patients who presented to the Netcare Breast Care Centre in Johannesburg over a one-year period (June 2015-June 2016). Patients who were not managed surgically were excluded from analysis. Demographic data and the details of the surgical procedures performed were collected and analysed.

RESULTS: Forty patients met the inclusion criteria, all of whom were female. The median patient age was 59 years (range 30-88 years). The majority of the tumours were small, with 29/40 tumours ≤ 5 cm (≤ T2) at presentation. Of the 40 patients, 18 were referred for neo-adjuvant chemotherapy. Surgical management was BCT in 19/40 patients and mastectomy in 21/40. In the BCT group, one patient underwent prosthetic reconstruction, while the rest were reconstructed by reduction mammaplasty (8/18), latissimus dorsi flap (6/18), local parenchymal flap (2/18) and thoracoepigastric flap (2/18). In the mastectomy group, 5/21 patients declined reconstruction. Of the remaining 16 patients, half elected to undergo immediate prosthetic reconstruction and half opted for autologous reconstruction. The autologous reconstructions performed in the mastectomy group were latissimus dorsi flap (4/8), thoracoepigastric flap (3/8) and a combination of thoracoepigastric/LICAP flap (1/8). All the tumours in both the BCT and mastectomy groups had clear resection margins.

CONCLUSION: BCT was feasible in approximately half of the patients in this case series. Breast conservation surgery presents a viable surgical alternative to mastectomy in patients with central breast tumours.