Pathology Report

[Barks]

My wife recently had a Left modified radical mastectomy with axillary dissection and a tram flap reconstruction. reconstruction and recovery has gone extremely well .

The first pathology report came back as non-invasive with (1) lymph node positive. This did not agree with the original biopsy report or the lymph node involvemnet so the surgeon ordered another patology report.

The (2nd) pathology report stated :

Infiltrating ductal carcinoma, .8 cm, grade 3; stage T1bN1Mx, extending to deep resection margin (along a approximate .3 cm front)

One lymph node positive out of six measuring .2cm with no extracapsular extension

Scattered foci of ductal carcinoma-in-situ (DCIS), classic comedo type (nuclear grade 3), solid and cribriform patterns, with nerosis, focally estending to .1 cm of deep resection margin.

The surgeon is recommending chemo which we understand however, he is also reconmmending a consult with a radiation oncologist because of positive margins.

It was our understanding that by having a mastectomy we eliminated the concern for positive margins by removing the breast. Also, the surgeon stated that they would not proceed with reconstruction if there was going to be a need for radiation.

Please help explain pathology findings and the need for radiation and the possible effects on the tram flap reconstuction. Thank You

[CCF-RN,MSN-rf]

Dear Barks:  The second pathology report makes more sense simply on the basis that a non-invasive cancer could not have spread to the lymph node.  The positive margin is of concern and radiation would be the typical next step to address local control of the disease.  Typically, a mastectomy does reduce the chances of positive margins but the tumor must have been very close to the chest wall.  If the tram flap is well vascularized (has good circulation), it stands to reason that it will be okay to radiate the area.  This is an area that the plastic surgeon and radiation oncologist should coordinate together, so that the field of radiation minimizes unnessary exposure to the reconstructed tissue.

[surgeon]

Having radiation to the area does not preclude future fashioning of a tram flap. It would certainly delay the timing, and would increase the chance of some degree of healing problems. But in fact it's the ideal method for reconstruction in a previously radiated field.