Georgios Exarchos1, Linda Metaxa2, Anastasia Constantinidou3, Michalis Kontos4. 1. 2nd Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece. 2. Radiology Department, St Bartholomew's Hospital, London, UK. 3. Medical School University of Cyprus and the BoC Oncology Centre, Nicosia, Cyprus. 4. 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
BACKGROUND: Delayed breast cellulitis (DBC) is a relatively rare complication following breast-conserving surgery. It is often challenging to distinguish DBC from other clinical conditions such as postoperative infection, inflammatory reaction following radiation, and recurrent inflammatory carcinoma. The definition of DBC, diagnostic approach, and treatment are not well established in the literature. METHODS: We performed a literature search with the keywords 'Delayed breast cellulitis' and 'Breast conservation therapy cellulitis', without limitations to the dates or the article types, in the PubMed database. Information about the number of cases with DBC, the age of the patients, the interval between the onset of symptoms and the time of surgery or radiotherapy, and the type and outcome of DBC treatment were reviewed and tabulated. RESULTS: We identified only 5 papers that were absolutely related to our subject, reflecting the fact that 'delayed breast cellulitis' is a fairly unknown term and the condition is rather underreported. Although most agree that DBC is primarily an aseptic inflammatory process, bacterial growth may contribute to its development or recurrence. Obesity, breast size, location of the breast tumor, removal of the axillary lymph nodes, and connective tissue disorders are considered as risk factors. There is no clear evidence on how DBC should be best managed. Antibiotic treatment is controversial, and many authors suggest anti-inflammatory agents or sole observation. Prevention of lymph stasis and its consequences with massage and skin care may be helpful. Despite the fact that malignancy is rare, in cases where the condition persists for more than 4 months, a core biopsy should be performed to rule out recurrent or second primary carcinoma. CONCLUSION: The correct diagnostic approach is essential as it provides patients with reassurance, minimizes anxiety, and prevents unnecessary medical investigations, treatments, and costs.
BACKGROUND: Delayed breast cellulitis (DBC) is a relatively rare complication following breast-conserving surgery. It is often challenging to distinguish DBC from other clinical conditions such as postoperative infection, inflammatory reaction following radiation, and recurrent inflammatory carcinoma. The definition of DBC, diagnostic approach, and treatment are not well established in the literature. METHODS: We performed a literature search with the keywords 'Delayed breast cellulitis' and 'Breast conservation therapy cellulitis', without limitations to the dates or the article types, in the PubMed database. Information about the number of cases with DBC, the age of the patients, the interval between the onset of symptoms and the time of surgery or radiotherapy, and the type and outcome of DBC treatment were reviewed and tabulated. RESULTS: We identified only 5 papers that were absolutely related to our subject, reflecting the fact that 'delayed breast cellulitis' is a fairly unknown term and the condition is rather underreported. Although most agree that DBC is primarily an aseptic inflammatory process, bacterial growth may contribute to its development or recurrence. Obesity, breast size, location of the breast tumor, removal of the axillary lymph nodes, and connective tissue disorders are considered as risk factors. There is no clear evidence on how DBC should be best managed. Antibiotic treatment is controversial, and many authors suggest anti-inflammatory agents or sole observation. Prevention of lymph stasis and its consequences with massage and skin care may be helpful. Despite the fact that malignancy is rare, in cases where the condition persists for more than 4 months, a core biopsy should be performed to rule out recurrent or second primary carcinoma. CONCLUSION: The correct diagnostic approach is essential as it provides patients with reassurance, minimizes anxiety, and prevents unnecessary medical investigations, treatments, and costs.
Authors: C Marchal; B Weber; B de Lafontan; M Resbeut; H Mignotte; P P du Chatelard; B Cutuli; M Reme-Saumon; A Broussier-Leroux; G Chaplain; F Lesaunier; J M Dilhuydy; J L Lagrange Journal: Int J Radiat Oncol Biol Phys Date: 1999-04-01 Impact factor: 7.038
Authors: Daniel J Indelicato; Stephen R Grobmyer; Heather Newlin; Christopher G Morris; Linda S Haigh; Edward M Copeland; Nancy Price Mendenhall Journal: Int J Radiat Oncol Biol Phys Date: 2006-12-01 Impact factor: 7.038
Authors: János Fodor; Zsolt Orosz; Eva Szabó; Zoltán Sulyok; Csaba Polgár; Zoltán Zaka; Tibor Major Journal: J Am Acad Dermatol Date: 2006-03 Impact factor: 11.527