Mastectomy in the management of patients with inflammatory breast cancer.

Inflammatory carcinoma of the breast is rare and lethal. Since the early 1940s, operation except for biopsy has been contraindicated in patients with inflammatory breast cancer. Results with radiotherapy alone and with radiotherapy and chemotherapy are reviewed. Results of treating patients with initial chemotherapy and debulking surgery in patients who respond to chemotherapy are presented. Mastectomy may be safely performed in selected patients with inflammatory breast cancer. Local control will improve quality of life. By removing the breast and residual tumor after chemotherapy and/or radiotherapy, fungation, ulceration, and some of the clinical and psychological problems of uncontrolled local disease may be avoided. Mastectomy should be performed only in patients who responded well to preoperative therapy. Patients who do not respond to chemotherapy should be treated with radiotherapy and should not undergo operation. This approach has not been detrimental to survival or to ultimately achieving local control of the disease.