[Experiences in the treatment of far advanced primary breast cancers, extensive tumor recurrences and radiation damage (reflections on on the value of surgical therapy)].

Ulcerating primary breast cancer, local recurrence with extension to the thoracic wall and skin and ulceration after radiation therapy, sometimes with malignant degeneration, call for interdisciplinary evaluation and treatment. For the benefit of the patient an effective cooperation of the involved specialties seems desirable at an early stage of management. We performed breast tumor resection and immediate coverage of the defect in 25 patients (median age 54 years). In choosing the reconstruction procedure great attention was paid to short hospitalization and the possibility of commencing cytostatic or radiation therapy as soon as possible. We are able in all cases to resect the open and partly infected, ulcerated and bleeding tumors and to close the defects completely by means of various flaps. Among the many flaps at our disposal to reconstruct the thoracic well defects, we prefer the cranial based, ipsi- or contralateral extended rectus abdominis flap.