How would you approach a locally recurrent HER2 positive breast cancer patient previously treated with TCHP, lumpectomy, and a year of adjuvant TDM-1?

Assuming that the patient's metastatic work-up is negative, and that the local recurrence is in the breast, limited in volume and resectable, standard local management would be a mastectomy, without post-mastectomy radiation (as she presumably received radiation after her lumpectomy). I also assume ...