Early Local Recurrence as Invasive Micropapillary Carcinoma after Skin-Sparing Mastectomy with Immediate Deep Inferior Epigastric Perforator Flap Reconstruction for Ductal Carcinoma in situ.

INTRODUCTION

Skin-sparing mastectomy with immediate breast reconstruction has been widely adopted to achieve both oncological safety and favorable cosmetic outcomes. Local recurrence after this procedure is generally considered a late event, and early postoperative recurrence at a brief period is uncommon. The mechanisms underlying early local recurrence after skin-sparing mastectomy, particularly in patients with ductal carcinoma in situ, remain incompletely understood. We report a rare case of early local recurrence as invasive micropapillary carcinoma following skin-sparing mastectomy with immediate autologous reconstruction for extensive ductal carcinoma in situ.

CASE PRESENTATION: A premenopausal woman in her forties was diagnosed with extensive ductal carcinoma in situ of the right breast and underwent skin-sparing mastectomy with sentinel lymph node biopsy and immediate breast reconstruction using a deep inferior epigastric perforator flap. The final pathological diagnosis was ductal carcinoma in situ with negative surgical margins, and no adjuvant therapy was administered. Ten months after surgery, she noticed a palpable mass in the reconstructed breast, located in the same quadrant as the primary tumor. Imaging studies revealed a well-defined mass, and core needle biopsy demonstrated the invasive micropapillary carcinoma. She was diagnosed with early local recurrence and underwent partial resection of the reconstructed breast. Histopathological examination confirmed invasive micropapillary carcinoma. Retrospective reevaluation of the initial surgical specimen revealed tumor cells with micropapillary architecture adjacent to a biopsy-related disrupted ductal wall, although no definite invasive component had been identified at the time of the initial diagnosis.

CONCLUSIONS

This case illustrates that early local recurrence as invasive carcinoma can occur after skin-sparing mastectomy with immediate reconstruction for extensive ductal carcinoma in situ. In addition to residual breast tissue in anatomically vulnerable areas, biopsy-related ductal disruption and aggressive tumor histology were considered potential contributing factors. Careful determination of the resection extent based on tumor location, as well as ensuring the inclusion of biopsy-related tissue changes within the resection field, may be important for improving local control.