Mammographic surveillance of breast cancer patients: should the mastectomy site be imaged?

This study evaluated the usefulness of routine mammography of the mastectomy site in women who have been treated for breast carcinoma.

From a retrospective review of medical records and mammographic examinations of 827 patients who had mastectomies, the following information was obtained: demographic data, type of breast reconstruction (if any), length of follow-up after mastectomy, evidence of local recurrence, and results of physical examination of the breast and mammography immediately before diagnosis of local recurrence.

Local recurrences of breast cancer were seen in 39 (4.5%) of the 859 breasts in the study group. All patients had a physical examination of the breast and mammography within 3 months of the diagnosis of recurrent breast carcinoma. Mammography of the mastectomy site did not show any recurrences that were not suspected on the basis of physical examination. For two of 20 patients, spot-compression views of palpable abnormalities showed thickening of the surgical scar. In four patients with pain in the chest wall, no abnormalities were found on physical examination or mammograms, but bone scintigrams showed metastasis to the ribs.

Our results indicate that mammographic imaging of the mastectomy site does not increase the detection of locally recurrent breast cancer.