CELLULITIS OF THE BREAST AS A COMPLICATION OF BREAST-CONSERVING SURGERY AND IRRADIATION

Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed celluli tis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-u p, 28 months: range, 24-65 months) who developed cellulitis before (n = 1). during (n = 2), or after (n = 2) breast irradiation were reviewe d. A consecutive series of BCT patients at Emory University was review ed to determine the incidence of this complication. Four of five women had an axillary dissection. yielding a median of 14 negative lymph no des (range, 6-22 nodes), Two of four patients developed axillary serom as requiring aspiration. In these four patients, only the breast was i rradiated. A fifth patient had no axillary dissection and had breast a nd supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis inc luded erythema, edema, tenderness, and warmth in all patients. Celluli tis was a relapsing problem for four of the five patients. The inciden ce of this complication in our series of BCT patients was similar to 1 %. Cellulitis in the ipsilateral breast can be a relapsing complicatio n of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis. Late cellulitis may be caused by a variet y of factors related to modifications of vascular and skin integrity b y surgery and radiotherapy. Prompt diagnosis and appropriate antibioti c therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic r esult.