Radical Mastectomy SANS Axillary Lymph Node Dissection for Large Phyllodes Tumor: a Guarantee Against Recurrence

Phyllodes tumor of the breast is a rare mixed tumor of epithelial and mesenchymal origin with an incidence of less than 1% of all primary breast tumors. This tumor is well known for its high potential for local recurrence ranging in 8–40% of patients. Excision of tumor with a 2-cm margin without raising skin flap along with overlying skin and underlying part of pectoralis major muscle described by our team seems to be a guarantee against local recurrence. It was a prospective cohort study conducted at the Department of Surgical Disciplines, AIIMS, New Delhi, India, from March 2011 to December 2016. Patients with large phyllodes tumor were managed with a “radical mastectomy without axillary lymph node dissection” whereas women with a small lesion were treated with a wide local excision with a 2-cm margin of healthy breast tissue all around the lesion following our surgical technique. Sixty-one women were enrolled in this study. Twenty-nine patients underwent wide local excision, and 32 patients with large, recurrent, or malignant tumors were managed by radical mastectomy without axillary lymph node dissection (ALND) (27 patients) and with ALND in 5 patients with enlarged axillary nodes. None of the patients have developed local recurrence till date with a follow-up period ranging from 2 to 59 months. Excision of tumor with a 2-cm margin without raising skin flap along with overlying skin and underlying part of pectoralis major muscle is a very effective technique to prevent local recurrence.