After a mean follow-up period of four years invasive chest wall recurrence had developed in three patients, all of which progressed further to develop distant metastases. It is of course preferable to avoid local recurrence. It is a treatment strategy which is expedient and reduces the need for intensive follow-up. As these figures demonstrate, though, mastectomy is not totally effective and local recurrences can and do occur. Thus the incentive to treat patients with DCIS using breast conserving techniques.
Conservative surgery allows preservation of the breast.
The decision-making process may be complicated, however, by the relevance of margin status and the need for additional treatment following conservative surgery if the excision margins are adequate. Alternatively, the effectiveness of additional treatment may also depend on the adequacy of the excision margins. Radiation, for example, can be associated with local side-effects, adds to the financial cost of treatment and can be inconvenient for the patient. Alternatively, mastectomy is not the most cosmetically acceptable outcome to many women. There is also the psychological morbidity associated with the disfiguring consequences of treatment, and the diagnosis of local recurrence.