In a young woman with large invasive breast carcinoma (case: pT3, lobular) s/p skin sparing mastectomy with positive anterior margin, what is the practical role for re-excision with or without PMRT?

The case has many nuances.

Is the margin positive focal or diffuse? Can a surgeon confidently go back to excise positive? If not, would proceed with PMRT and boost quadrant where disease was present before surgery. Counsel the patient about reconstruction complications and the need for additional su...

I would discuss with the surgeon about the margin and whether it was a real positive margin. If so, and it can be localized, I do favor re-excision when possible.

In terms of reconstruction, if the reconstruction is subpectoral and the anterior margin, not commonly an issue. If prepectoral and anter...