Rotational Advancement Flap Quadrantectomy
A 59-year-old female with a diagnosis of invasive ductal carcinoma (1.75 cm), ER/PR positive, Her-2/neu negative, and grade 2 and focal DCIS underwent right partial mastectomy (upper outer quadrant) at an outside institution, as part of breast conservation therapy. Final pathology demonstrated the presence of positive resection margin and patient subsequently transferred care to our institution. Re-excision segmental mastectomy and sentinel lymph node mapping were planned, in addition to reconstruction of the segmental mastectomy defect with local tissue rearrangement. The patient underwent an uneventful surgery and was subsequently treated with adjuvant radiation; breast and axilla received a total of 42.56 Gy in 16 fractions, and the operative bed was boosted with an additional 12.5 Gy in 5 fractions. Patient discontinued her treatment with Femara, secondary to postmenopausal bleeding, and continued her therapy with exemestane. Final pathology result after re-excision demonstrated the presence of cauterized atypical glands, most consistent with invasive ductal carcinoma, measuring 2.5 mm in greatest dimension, present 1 mm from the anterior-inferior aspect of the medial margin. It also showed separate scattered atypical glands in a 4 mm area, consistent with invasive ductal carcinoma, low grade, present 4 mm from the closest inferior medial margin.