A 55-year-old woman presented with a chest wall lump two years after a left modified radical mastectomy for stage I (T1c, N0, M0) infiltrating ductal carcinoma (see breast cancer). CT scan shows the area of the lesion overlying the left border of the lower manubrium. Excisional biopsy showed a 1.2cm infiltrating ductal carcinoma, grade III/III, with a positive deep margin.
The patient was taken for chest wall resection to attain local control. The 5 cm margins are marked, along with the incisions for the TRAM reconstruction (see unilateral TRAM flap). The TRAM was contingent on preservation of the right internal mammary artery. If that was not possible, latissimus dorsi flap (see latissimus flap) reconsruction was planned.
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