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surgical options for phyllodes tumor
I recently had a 5.6 cm tumor, which had been diagnosed through core needle biopsy as a fibroadenoma 6 years ago and growing slowly since then, removed from my breast. Pathology report said benign phyllodes with margin involvement. Because of an extensive family history of cancer, including breast, my slides were sent to MSKCC for a second opinion. Path report returned as low grade malignant phyllodes extending to margins. My question: Should I just go back for more surgery to ensure clear margins, should I have wide excision with radiation, or should I have a mastectomy? I am small breasted and the surgeon advises that the wide excision is likely to be disfiguring.  
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Hi,
Well, wide local excision with removal of margins is the most common surgery in a case of phyllodes tumor. The tumor is re excised in case of recurrence and in extreme cases a mastectomy may be done. The rates of recurrence are very low and depend on the histology or type of tumor cells. This needs to be discussed with your surgeon. Also the usual plan of follow up is a clinical evaluation every 6 months , and a mamogram done annually. You are in the high risk category because of the strong family history of breast cancer. The tumor itself does not increase your chances of breast cancer, but recurrence to local sites or distant sites has to be kept in mind, and regular follow ups done. Goodluck.
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