Salvage mastectomy.

Local-regional relapse after breast-conserving surgery and radiation therapy is operable and not associated with concurrent distant metastases in most cases. Salvage mastectomy results in local-regional control for most patients. The extent of the surgery relates to the extent of the local-regional recurrence and does not carry an increased complication rate. The outcome of salvage mastectomy depends on the disease-free interval from initial breast-conserving surgery and radiation therapy to local-regional recurrence. Additional factors, such as the extent and histologic type of the recurrence, as well as the axillary lymph node status, either at the time of initial breast conservation or at salvage mastectomy, may influence outcome and require further study. Prospective trials are required to determine the safety of further breast-conserving surgery after local-regional relapse and the role of systemic therapy in improving postsalvage survival.