A 45-year-old woman with a history of breast conservation and radiation for right breast carcinoma five years ago now presents with a new 2.5 cm mass in the ipsilateral breast at a different site. Core biopsy confirms invasive ductal carcinoma. What is the most appropriate surgical management?

• A Repeat wide local excision of the new lesion
• B Neoadjuvant chemotherapy followed by lumpectomy
• C Radical mastectomy
• D Simple mastectomy with sentinel lymph node biopsy ✓

Explanation

Local recurrence in the ipsilateral breast after prior breast conservation and radiation is treated with mastectomy because re-irradiation is generally not feasible. Sentinel lymph node biopsy may be considered though accuracy is reduced after prior axillary surgery. Repeat lumpectomy is contraindicated due to prior radiation. Radical mastectomy is not routinely indicated for local recurrence without chest wall fixation.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.