A Late Complication of Fat Autografting in Breast Augmentation

Abstract

Sir: Cystosarcoma phyllodes of the breast is a rare neoplasia, representing not even 1 percent (0.3 to 0.9 percent) of all mammary tumors.1–3 Wide surgical excision surely represents the preferred initial therapy for such a disease, which can become otherwise extremely aggressive.4,5 We report a case of a 55-year-old Caucasian woman affected by a multirecurrent cystosarcoma phyllodes of the breast. A peculiarity of the case was the extremely high number of surgical procedures she underwent (37 in all) and the absence of response to radiotherapy, which represents, together with surgery, the therapy of choice. This patient was referred to our department in December of 2004. She presented with a wide lesion, diagnosed as cystosarcoma phyllodes elsewhere, on her left thorax wall, which had already been excised several times and which recurred after each of the treatments performed. In February of 2004, a complete screening was performed, including ultrasonography of both axillas; computed tomographic scan of the thorax, brain, and abdomen; and a total body positron emission tomographic scan. The screening revealed multiple occurrences of lymphadenopathy and several other hepatic, pulmonary, and mediastinal lesions. Between March and November of 2004, the patient underwent two cycles of presurgical radiotherapy (35 cycles of 6000 Gy in the left thoracic area, shoulders, and axilla; 11 cycles of 33,000 cGy in the thoracic wall) and chemotherapy with adriamycin and cyclophosphamide. After this, no evidence of clinical improvement was observed. In January of 2005, the patient underwent, in our hospital, a wide excision of the tumor on the left hemithorax, and multiple frozen sections revealed a free margin lesion. A rectus abdominis myocutaneous flap was harvested because other surgical options had already been used previously. Postoperative recovery was uneventful and the patient could be discharged 6 days after surgery. Although no sign of recurrence was observed at 3- and 6-month follow-up, 7 months postoperatively, the patient showed, despite the negativity of the previous frozen sections, the presence of a hard node in the axilla region, followed by several other nodes (Fig. 1).Fig. 1.: Recurrence of a cystosarcoma phyllodes of the left breast presenting several nodes on the left thorax wall, 7 months after the thirty-seventh surgical procedure, despite negativity of the frozen sections.The patient then underwent multiple cycles of radiation therapy, with no signs of improvement, and three cycles of chemotherapy, again with no signs of improvement. Together with the oncologist, we decided then to attempt a new treatment, which consisted of the administration of a continuous infusion of systemic chemotherapy composed of iphosphamide and mesna to be administered over 14 days and to be repeated every 4 weeks for a 3-month period. The results obtained were surprising, with a decrease in the dimensions of the nodes, which had almost disappeared (Fig. 2).Fig. 2.: Important decrease in dimensions of the nodes 3 months after the beginning of continuous chemotherapy with iphosphamide and mesna.To date, the patient is undergoing further treatment with further reduction of volume and hardness of the lesions. This treatment, not yet reported in the literature for the treatment of cystosarcoma phyllodes, seems to be effective in the reduction of the lesions of this particular tumor. Giovanni Di Benedetto, M.D., Ph.D. Vanessa Sperti, M.D. Luca Grassetti, M.D. William Forlini, M.D. Alessandro Scalise, M.D. Aldo Bertani, M.D., Ph.D. Department of Plastic and Reconstructive Surgery Marche Polytechnical University Medical School Ancona, Italy