Patient with a large multifocal  breast cancer.

• 54-year-old lady who presents with a 3cm lump at the 3 o’clock position of her right breast, She recently started on HRT and thought this was a breast cyst. She was a heavy smoker and slightly overweight.

• Right mammogram and breast ultrasound showed the lump looked malignant and there was a thickened right axillary lymph node. Biopsy confirms a grade 3 Invasive ductal carcinoma, ER +ve, PR+ve, HER2 negative. The biopsy unfortunately caused some bruising in her axilla (armpit) area. That biopsy confirm a lymph node metastasis. Breast MRI showed the right breast cancer measured 41mm (quite large).  Staging CT ( abdomen, pelvis and chest) showed no distant metastasis.

• The multidisciplinary (MDT) meeting recommended a Wide Local Excision ( lumpectomy ) and axillary clearance operation. Even though the patient had a  fairly large breast, she did not want to alter the size and shape through a simple Wide Local Excision (WLE) operation. In order to achieve this, a LICAP perforator flap was added to operation. The patient had to stop smoking upon agreeing to this operation.

• During the operation, the lump was excised via a curved incision from 7-11 o’clock edge of the right breast. The flap was fashioned from excess fat and skin tissue (refer to pre-op picture) in the lower part of the right armpit and rotated into the breast cavity left by the WLE.

• The operation was uneventful, the patient recovered quickly and her wound healed well. Post-op histology showed a 27mm BC with clear margins, 1 lymph node metastasis out of 7 lymph nodes. An Oncotype Dx test recommended chemotherapy in the form of EC and Taxol which took 5 months. After that, she underwent right whole breast radiotherapy.

• At the time of writing this, she was just about to start Letrazole (pending her menopausal profile blood test). The right breast is soft , comfortable and symmetrical to the left breast.