Surgery for giant tumours of the breast: a 15 year review

Background: Giant tumours of the breast tend to occur in the adolescent age group. Racial predilection has been noted in the literature. The mass often occupies most of the breast, leading to its distortion. Many authors have advocated a mastectomy for benign tumours that severely distort the breast. Giant benign tumours when treated by simple excision risk persistence of asymmetry. To avoid this asymmetry, some authors have resorted to excision and immediate reduction mammaplasty. The aim of this retrospective study was a report on giant tumours of the breast presenting to a plastic surgery unit and to analyse demographic factors, clinical presentations, tumour pathology, management, complications, as well as patient and breast outcomes.Methods: Medical records of patients with giant tumours were retrospectively analysed for assessing demographic factors, clinical presentation, tumour pathology, the technique of surgery performed and patient and breast outcomes in a single hospital setting. Breast outcomes were rated by panel of 4 experienced plastic surgeons using the 4 Point Likert scale. Their ratings were statistically analysed for inter-rater agreement.Results: Twenty-three subjects were identified to have giant tumours of the breast. Of these South African patients, 19 were black, 3 were Indian and 1 was of mixed ethnicity. The age range was 12­49 years(y) with an average of 19y. All masses were palpable. The final pathological diagnosis was fibrocystic disease in 3, giant fibroadenoma in 14, phyllodes tumour in 4, and hamartoma in 2. The size range was 10­45 cm with a median size of 18 cm. All but one patient had simple excision followed by immediate reduction mammaplasty. Twenty patients were assessed after operation. A minimum of 1 to a maximum of 4 patients per reviewer showed unsatisfactory outcomes and a minimum of 18 to a maximum of 21patients per reviewer showed satisfactory to excellent outcomes. The overall agreement between assessors for this was 84%. Conclusion: Benign giant tumours (> 10 cm) of the breast are suitably managed by excision of the mass and a reduction mammoplasty technique of reconstruction

Phyllodes Tumour in Young Female Adults in Port Harcourt; Nigeria

Background: Phyllodes tumour of the breast is a rare and potentially aggressive tumour. Little information is available regarding the optimal management of this tumour and rarer still; are data regarding survival. We report our experience in the diagnosis; management and outcome of phyllodes tumour. Patients and Methods: The hospital case notes of adolescent female patients found to have phyllodes tumour from 1997 to 2007 were identified from the medical records department of the hospital. Data extracted included sex; age; presenting symptoms; anatomical site of lesion and clinical evaluation including approximate size of the breast masses. Results of investigations including haemogram; urea and electrolytes; chest xray; ultrasonography; tru-cut and excision biopsy; surgical treatment and outcome of treatment were obtained. The follow up visits to the outpatient clinic were also noted. Results: There were 17 females aged between 25 and 30 years. Five patients had previous excision biopsy of fibrodenoma from the ipsilateral breasts when they were teenagers. The median tumour size was 17.5 cm in diameter. There were no clinical features suggestive of malignancy. The chest radiographs were within normal limits. Histopathological findings showed that ten (58.82) patients had the benign variety while seven (41.18) had the borderline variety. All had a wide excision of the tumour but were not offered any adjuvant therapy. Conclusion: Early diagnosis and treatment with adequate surgical margins are essential in the successful management of phyllodes tumour

Malignant Phylliodes Tumours: Results of Breast Conserving Surgery and Immediate Reconstruction

Background: Malignant phylliodes tumour (MPT) is a rare breast tumor. Surgery is the mainstay in treatment but varies from local resection to modified radical mastectomy. In this study; we present our experience using wide local excision or subcutaneous mastectomy and immediate breast reconstruction in the management of MPT. Methods and Results: Twenty-three recurrent MPT and ten patients with histological evidence of MPT were included. All patients with recurrent MPT (n=23) had subcutaneous mastectomy; tow centimeter wide excision of the scar and immediate breast reconstruction with either Latissimus Dorsi (LD) myocutaneous flap (n= 10) or Latissimus Dorsi muscle flap (n=13). Seven of the newly diagnosed patients had wide local excision of the tumor; reconstruction with LD muscle flap; tow had wide local excision and reduction of contra lateral breast; and one had subcutaneous mastectomy and silicon implant. The margin resection varied between five and fifteen centimeter in wide local resection group and subcutaneous mastectomy group respectively and the size of tumors varied between five and fifteen centimeters in diameter. Discussion: During the follow up period; which ranged between twenty-four and eighty-four months one local recurrence; was recorded (3.03) and none of the patients had distant metastasis or regional lymph nodes involvement. This approach has secured wider excision of MPT; offered breast reconstruction; and has reduced the chances of recurrence in our patients