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The surgical management of angiosarcoma of the breast—a single institution experience

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Angiosarcoma of the breast is a rare and aggressive tumour of the vascular endothelium. It may arise spontaneously or secondary to radiation. We present our experience of managing breast angiosarcoma, the largest single institution case series from the UK to date along with a summary of the relevant literature.

Methods

Data on all patients with breast angiosarcoma treated in our unit were prospectively recorded (2002–2014). Demographics, surgical details and outcomes were analysed.

Results

Eighteen female patients presented with breast angiosarcoma. Sixteen patients previously underwent adjuvant radiotherapy following surgery for breast carcinoma; the mean duration between radiotherapy and angiosarcoma development was 8.4 years (range 3–21). Resections were as follows: radical mastectomy (n = 14), simple mastectomy (n = 1) and wide local excision (n = 3). Reconstruction was undertaken as follows: pedicled lattisimus dorsi (LD) musculocutaneous flap (n = 5), pedicled LD muscle flap and split skin graft (n = 7), free deep inferior epigastric perforator (DIEP) flap (n = 1), pedicled vertical rectus abdominus muscle (VRAM) flap and split skin graft (n = 1), pedicled LD muscle and pedicled VRAM muscle flaps and split skin graft (n = 1), pedicled LD muscle and pedicled (contralateral) pectoralis major muscle flaps and split skin graft (n = 1) and direct closure (n = 2). Three patients developed local recurrence; mean duration from resection to recurrence was 12 months (range 9–19). Three patients developed metastasis. Seven patients (38.8 %) died; median survival from presentation was 19 months (range 2–55 months). The remaining eleven patients remain well with no disease recurrence; mean follow-up was 38 months (range 4–125). The estimated 5-year survival (Kaplan-Meier equation) in our cohort was 49 %.

Conclusions

Breast angiosarcomas are rare and challenging to manage. Successful outcomes can be achieved by early, aggressive resection and appropriate reconstruction.

Level of Evidence: Level IV, therapeutic study.

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No ethical approval was sought for this article. This article contains no identifiable patient data. Written consent for publication of clinical photographs was obtained from all patients whose images are included in this article. Patients gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were be omitted.

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Authors and Affiliations

  1. Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK

    Timothy Patrick Crowley, David C. G. Sainsbury, Daniel M. Crowley, Richard H. Milner & Maniram Ragbir

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  1. Timothy Patrick Crowley
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  2. David C. G. Sainsbury
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Correspondence to Timothy Patrick Crowley.

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Crowley, T.P., Sainsbury, D.C.G., Crowley, D.M. et al. The surgical management of angiosarcoma of the breast—a single institution experience. Eur J Plast Surg 37, 489–496 (2014). https://doi.org/10.1007/s00238-014-0972-2

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  • DOI: https://doi.org/10.1007/s00238-014-0972-2

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