REDUCTION MAMMAPLASTY AND RADIATION-THERAPY CAN ALLOW BREAST-CONSERVATION IN PATIENTS WITH BREAST CANCERS NOT INITIALLY TREATABLE BY TUMORECTOMY

A protocol combining reduction mammoplasty (RM) and radiation therapy was developed as an alternative to mastectomy In patients with breast cancers larger than 3 cm in diameter. This protocol was used in 51 pat ients between 1983 and 1990. 1) Indications were extensive microcalcif ications (n = 17, 33 %); 2) residual tumor after neoadjuvant therapy l arger than 4 cm in diameter (n = 18; 35 %); 3) extensive DCIS (n = 4; 8 %) or tumor located within an area of fibrocystic disease (n = 6; 12 %); 4) and presence of a bifocal lesion (n = 6; 12%). Surgery consist ed of tumorectomy removing a wide margin of skin and mammary gland, fo llowed by immediate remodeling of the breast, same-side axillary node clearance, and symmetrization of the other breast. A radiation dose of 45 Gy was delivered to the entire mammary gland. Adjuvant therapy was given before and/or after therapy according to the institution's rout ine breast cancer protocol. During the mean follow-up of 8,1 years, fo ur patients (8 %) developed a local recurrence, which was treated surg ically The five-year disease-free survival rate was 76 %. The cosmetic result was good or very good in 78 % of cases. RM plus RT is a reason able alternative to mastectomy in patients with large breast cancers, although further work is needed to refine its indications.