We would like to report our data and behavior with regard to histologic analysis of mastectomy scars following breast reconstruction. Warner et al. reported an impressive record of cases, counting 433 patients who had 455 scars histologically processed.1 The authors identified four mastectomy scars infiltrated in three patients (0.9 percent). Interestingly, the patient in case 1 underwent mastectomy after wide local excision and the patient described in case 3 underwent wide local excision and salvage mastectomy because of local recurrence 5 years later; the patient in case 2 had axillary lymph node involvement and underwent bilateral mastectomy, which proves advanced, aggressive disease.
Two of three patients had a conservative approach (wide local excision), validating their further statement that locoregional recurrences are higher following breast-conservation therapy. On the contrary, the patient in case 2 had advanced, aggressive disease with nodal involvement and underwent radical mastectomy.
We submitted 72 scars for histopathologic examination. All samples were harvested at the time of definitive implant placement in patients who had had previous immediate breast reconstruction with a tissue expander after radical mastectomy. Formalin-preserved scars were sectioned and random sampled using hematoxylin and eosin staining and microscopic examination. No positive sample has been recorded. The average age at the time of reconstruction was 51.6 years (range, 22 to 72 years), and the mean interval from mastectomy to scar sampling was 16 months (range, 6 to 22 months).
We routinely submit mammary scars for histopathologic examination if some remodeling surgery after breast-conservation surgery is requested. In our opinion, histopathologic examination of radical mastectomy scars does not add further benefit. Nonetheless, we agree with the authors' statement that the question of what percentage of scar recurrence is significant and needs histologic processing is open.
Scar involvement after skin-sparing or nipple-sparing mastectomy, which have in selected cases the same local recurrence rate as radical mastectomy, should be investigated. Indeed, the risk of locoregional recurrence is dependent on several other factors, such as histologic type of tumor, lymph node involvement, adjuvant therapy, follow-up, and histopathologic processing which, as a whole, make standardizing collected data difficult.
Tommaso Agostini, M.D.
Andrea Mori, M.D.
Mario Dini, M.D., Ph.D.
Department of Plastic and Reconstructive
University of Florence
The authors have no commercial associations that may pose or create a conflict of interest with information presented in this letter.
1.Warner RM, Wallace DL, Ferran NA, et al. Mastectomy scars following breast reconstruction: Should routine histologic analysis be performed? Plast Reconstr Surg
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