Restaging of all patients should occur following the detection of local recurrence. For single-spot recurrence occurring many years after the original surgery, further local excision alone has been reported to provide good local control. A change of systemic therapy, possibly from tamoxifen to a progestogen or aromatase inhibitor or the addition of radiotherapy might also be considered. For multiple-spot recurrence in patients who have not previously received radiotherapy then this might be considered as an option. For wide spread field changes standard chemotherapy regimes are usually considered but disease control with these is often disappointing.
Intraarterial chemotherapy is often effective in some patients.
Failure to halt the progression of local recurrence can lead to cancer en-cuirase in which the chest wall becomes encircled with a tumour mass. This is a most unpleasant and debilitating condition for the patient. Symptoms may be improved with the use of topical metronidazole and charcoal impregnated dressings. Recent papers Blacklay P F, Campbell F S, Hinton S P et al. Patterns of flap recurrence following mastectomy.