Cellulitis of the breast as a complication of breast-conserving surgery and irradiation

Am J Clin Oncol. 1997 Aug;20(4):338-41. doi: 10.1097/00000421-199708000-00003.

Abstract

Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed cellulitis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-up, 28 months; range, 24-65 months) who developed cellulitis before (n = 1), during (n = 2), or after (n = 2) breast irradiation were reviewed. A consecutive series of BCT patients at Emory University was reviewed to determine the incidence of this complication. Four of five women had an axillary dissection, yielding a median of 14 negative lymph nodes (range, 6-22 nodes). Two of four patients developed axillary seromas requiring aspiration. In these four patients, only the breast was irradiated. A fifth patient had no axillary dissection and had breast and supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis included erythema, edema, tenderness, and warmth in all patients. Cellulitis was a relapsing problem for four of the five patients. The incidence of this complication in our series of BCT patients was approximately 1%. Cellulitis in the ipsilateral breast can be a relapsing complication of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis. Late cellulitis may be caused by a variety of factors related to modifications of vascular and skin integrity by surgery and radiotherapy. Prompt diagnosis and appropriate antibiotic therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic result.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Axilla / pathology
  • Breast / radiation effects*
  • Breast Diseases / drug therapy
  • Breast Diseases / etiology*
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery
  • Carcinoma, Ductal, Breast / radiotherapy*
  • Carcinoma, Ductal, Breast / surgery
  • Cellulitis / drug therapy
  • Cellulitis / etiology*
  • Cysts / etiology
  • Cysts / therapy
  • Edema / etiology
  • Erythema / etiology
  • Exudates and Transudates
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Lymph Node Excision / adverse effects
  • Mastectomy, Segmental / adverse effects*
  • Middle Aged
  • Pain / etiology
  • Paracentesis
  • Radiotherapy / adverse effects
  • Radiotherapy Dosage
  • Recurrence
  • Skin Temperature

Substances

  • Anti-Bacterial Agents