title: Omental transposition for recurrent breast carcinoma following limited surgical excision and radiation therapy.
abstract: Failure to control local disease following limited surgical excision and radiotherapy for primary treatment of breast carcinoma often precludes the use of conventional mastectomy techniques. This series reports the use of mastectomy and omental transposition on a gastroepiploic pedicle and delayed skin grafting in 17 such patients. The transposition of omentum permits removal of neoplastic and secondarily infected tissue including sternum, ribs and chest wall muscles if necessary. Fourteen patients underwent hormonal manipulation and 8 patients chemotherapy before surgical referral, which was often as a last resort for ulcerated and secondarily infected masses. Three patients required concomitant chest wall excision. There was no mortality and no long-term morbidity. Local disease was completely eradicated in 9 patients, although 2 now have distant disease; 4 patients had marked symptomatic improvement despite failure to control local disease and 4 patients had poor results. Dermal lymphatic involvement and failure to resect all macroscopic disease accounted for all of the local failures. Omental transposition can provide a safe, effective and occasionally curative surgical means of dealing with these difficult local recurrences in irradiated breasts.
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D002277:Carcinoma / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009852:Omentum / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps