Appropriate Margins for Excision of 2 cm Benign Phyllodes Tumor

[TX209B]

Pre-op dx of benign phyllodes tumor.  Breast surgeon planned wide local excision (2 cm all the way around).  However, path shows only 1 cm wide margin and in one place only a 1 mm margin.  Surgeon maintains that margin was clean.  Said that patient  may opt for further surgery to widen margin, but surgeon did not think that was needed.  He rec 6 month or 12 month f/u mammogram.  If chance of local recurrence is 20% w/o wide local excision, then I'd like to know what % of local recurrence is malignant when first occurrence is benign...that's my question.  Also, how soon do I go back into surgery to widen margin?  I have heard that disrupting a surgical site increases chance of developing a malignancy????  Another serious question that I have is should I consult with an oncologist (my breast surgeon did not think that was necessary but I am wanting a second opinion).

[TX209B]

Thank you, especially for sharing your thoughts re:  the purpose of additional surgery.  Your help is much appreciated!!

[TX209B]

Thank you so much for responding with info re:  additional surgery & how it wouldn't increase the chance of developing a malignancy.  I may opt to do the re-excision & want to stick with the breast surgeon I have now.  (Had another breast surgeon in the recent past).  Your help is much appreciated!

[bluebutterfly2222]

The 2cm clear margin is recommended for benign phyllodes tumors, and much larger ones for a malignant one. (The borderline or frankly malignant ones have a tendency to metastasize.)

The figures I have seen suggest that benign phyllodes tend to recur in 20-35% of patients, esp. if the woman is over 45.  I did not see mention of the concern  of those recurrences being malignant, though. I think the purpose of additional surgery to get a larger clear margin would be primarily to avoid having the tumor grow back, requiring more extensive surgery or a mastectomy.

But all of your questions would best be answered by a breast surgeon/breast specialist, to make sure you have the most recent and most accurate information on which to base your decision about having the additional sugery to obtain the recommended clear margins.

Best wishes...

[japdip]

If you want a true second opinion then you should consult another Breast Surgeon and take all your records/reports with you to your appointment. It is less likely that Phyllodes will recur when only one tumor is the issue; more likely when there are multiple tumors initially. Additional surgery would not increase the chance of developing a malignancy ... especially since the tumor was benign. I think the 6 month recommendation is an excellent one for at least the 1st year following surgery. Phyllodes can recur but I know of no definite % for this; at least not one that I would care to state.   Regards ...