ABSTRACT
Finding microscopically positive margins after breast lumpectomy is generally an indication for re-excision. However many re-excision results are inaccurate or negative, thus not contributing to disease control but may increase patient morbidity. This study attempts to re-evaluate our experience if mastectomies were justified in positive or close margins and to set standard guidelines in the management. A 14 year review operative and histopathology records for the period from 1990-2004 was conducted. All breast specimens reports with positive or close margins which underwent further re-excisions were reviewed. The total identified number was 127, size ranged between 3-5 cm on gross specimen measurement. those reported with positive margins excisions were 75, while those with close margin reports were 52 patients. All patients underwent re-excision in the form of either mastectomy or wide local excision based on the surgeon's preference. The histopathology tissue review revealed positive re-excisions in 67 [52.7%] while 60 [47.2%] patients were negative residual tumour, out of these 40 were previously reported with close margins and 20 of the with positive margins. Of the negative re-excisions 27 patients underwent mastectomy which was considerd an over treatment for these young patients. In conclusion surgical margins remain the best predictor of residual disease in the breast though they are occasionally inaccurate. Mastectomy may be the only option in some cases to eradicate the disease yet it should be reserved for those with locally advanced disease, multi-focal or high grade tumours