“Residual” mammary carcinoma following simulated partial mastectomy

Abstract

Treatment of mammary carcinoma by partial mastectomy rather than by total mastectomy and axillary dissection may diminish the chances of long-term cure by risking incomplete removal of all local carcinoma at the initial operation. This study was undertaken to determine by pathologic examination how often carcinoma might remain in the breast and axilla after partial mastectomy. The operation was simulated in 203 mastectomy specimens after operations for unilateral invasive carcinoma. In so far as could be determined on gross examination, the entire primary lesion was included in the quadrant which was excised in the simulated procedure. Among 100 women with primary lesions less than 2 cm in diameter, 26% had carcinoma in the breast which remained after simulated partial mastectomy. Six percent of them also had axillary node metastases. An additional 30% only had axillary node metastases. When the primary lesion was more than 2 cm in diameter, 38% of patients had carcinoma in the breast after simulated partial mastectomy, of whom 29% also had axillary metastases. After simulated partial mastectomy, carcinoma was found in 80% of breasts from patients with lesions in the subareolar area, in contrast with 25-3570 of patients with a primary carcinoma in one of the four quadrants. None of the 9 patients with medullary and colloid carcinomas that measured under 2 cm had axillary metastases or carcinoma in the breast outside of the primary quadrant. The findings suggested that a familial history of breast carcinoma or a large primary lesion may be associated more often with multifocal disease, but factors such as age at diagnosis, axillary status, and the mammogram report did not have significant predictive value for distinguishing between patients who did or did not have carcinoma in breast tissue after the primary had been removed by a simulated partial mastectomy. NTENSE CONTROVERSY HAS BEEN GENERATED I in the past several years by the proposal that total mastectomy is now an unnecessarily extensive and disfiguring operation for the treatment of primary operable invasive breast carcinoma.* Advocates of conservative surgery contend that radical mastectomy was essential in the past because many more patients presented with advanced disease.' They maintain that today the majority of patients are being treated at an Presented in part at the 27th Annual Meeting of the James Ewing Society. Maui. HI, April 8-13, 1974. The authors express their appreciation for the invaluable assistance of Miss Jane Taylor and Miss Donna Nager in the preparation of this study.Received for publication November 15, 1974. earlier stage and that it is possible to select patients who can be cured by partial rather than total mastectomy.2 Two serious difficulties must be faced in selecting patients for partial mastectomy. First, the operation should remove all carcinoma in the breast if it is to achieve maximum local control. To ensure this requires a reliable method of identifying patients with carcinoma limited to a single quadrant of the brea...

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