Immediate TRAM reconstruction for stage III breast cancer is not associated with a delay in adjuvant therapy or an increased risk of local relapse. It facilitates wide resection of involved skin without skin grafting. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of stage III breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.

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Fig. 1. A Anteroposterior and B lateral views of the right ankle show multiple ill-defined lytic lesions of the tibia, fibula, and calcaneus. Note the erosion of the cortex of the fibula (arrow) Clinical informationA 31-year-old male patient presented at the orthopedic clinic complaining of a painful swelling over his right ankle. Four months previously he had hurt his leg during physical exercise. The pain and swelling steadily increased, limiting his daily physical activity, and he lost 30 lb (13.6 kg) in weight. The previous medical history was unremarkable apart from the congenital absence of the second and fourth fingcrs on thc right hand. Physical examination revealed swelling and tenderness over the right ankle and foot. The range of motion was limited due to pain. Laboratory findings were within normal limits. Total body technetium 99m bone scan showed increased uptake of the right lower leg and ankle.Radiological examination of the right ankle showed numerous lucent lesions along the distal end of the tibia, fibula, and calcaneus (Fig. 1). Computed tomography (CT) confirmed extensive destruction. Magnetic resonance imaging (MRI) showed an elongated soft tissue mass that extended from the tarsal region through the middle third of the right leg (Figs. 2, 3).

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