Local Recurrence After Breast Conservation and Radiation: Mastectomy and Immediate Reconstruction with a Latissimus Dorsi (LD) Flap
The 46-year-old premenopausal woman had a prior history of breast conservation surgery and sentinel node biopsy followed by radiation and endocrine treatment for a 15 mm invasive G2 receptor-positive sentinel node-negative cancer in the lower outer quadrant of the left breast 6 years ago. Follow-up mammography found suspicious microcalcifications in the lower outer quadrant. Invasive cancer with intraductal carcinoma in situ of intermediate grade was histologically confirmed. The microcalcifications were localized in the lower outer quadrant and did not extend to the nipple-areola complex (NAC). The breast was of small size with minimal ptosis and showed some tissue deficiency in the lower outer quadrant from the prior quadrantectomy. The scar from the previous qudrantectomy was in the left inframammary fold (Fig. 58.1a, b). Nipple-sparing mastectomy and immediate reconstruction with a latissimus dorsi (LD) flap were planned (Fig. 58.1c).