Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge

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These tumors are characterized by rapid stromal growth and can reach significant sizes, particularly in malignant cases, necessitating aggressive surgical management due to their high recurrence risk. In this case report, we present a 40-year-old Tunisian woman diagnosed with a giant phyllodes sarcoma. The patient experienced considerable physical and psychological impacts, including impaired mobility, body image disruption, and professional limitations. Clinical examination and imaging confirmed the presence of a large lobulated mass in the left breast, with no signs of distant metastasis. A multidisciplinary team recommended a total mastectomy with immediate reconstruction using a latissimus dorsi myocutaneous flap. This approach aimed to restore breast contour while addressing both oncologic and aesthetic needs. The procedure was successful, with the excised tumor weighing 7 kg. Postoperatively, the patient received close monitoring and psychological support, emphasizing the importance of a holistic approach to recovery. This case underscores the complexities of managing giant phyllodes sarcoma, highlighting the value of a timely surgical intervention combined with effective reconstructive techniques. It also emphasizes the need for individualized treatment plans that consider both functional and aesthetic outcomes to optimize patient recovery and quality of life" } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-130/v1", "name": "Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy..." } } ] } Home Browse Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Toumi D, Cheikh Mohamed C, Hajji A et al. Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :130 ( https://doi.org/10.12688/f1000research.159059.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge [version 1; peer review: 1 approved with reservations] Dhekra Toumi 1 , Chayma Cheikh Mohamed https://orcid.org/0009-0004-8360-4543 1 , Ahmed Hajji 1 , [...] Imen Ghaddab https://orcid.org/0000-0002-7341-199X 1 , Malak Medemagh https://orcid.org/0009-0009-1278-5777 1 , Hanane Lazreg 1 , Yasmine Ben Ali 1 , Sana Alouani 1 , Jawaher Hammedi 1 , Selma Souilah 1 , Rihab Barouni 1 , Hiba Ben Abdelhafidh https://orcid.org/0009-0006-0134-611X 1 , Sana bouakez 1 , Thana Mahfoudhi 1 , Olfa Zoukar https://orcid.org/0000-0001-9746-3359 1 , Haifa Bergaoui 1 , Raja Faleh 1 Dhekra Toumi 1 , Chayma Cheikh Mohamed https://orcid.org/0009-0004-8360-4543 1 , [...] Ahmed Hajji 1 , Imen Ghaddab https://orcid.org/0000-0002-7341-199X 1 , Malak Medemagh https://orcid.org/0009-0009-1278-5777 1 , Hanane Lazreg 1 , Yasmine Ben Ali 1 , Sana Alouani 1 , Jawaher Hammedi 1 , Selma Souilah 1 , Rihab Barouni 1 , Hiba Ben Abdelhafidh https://orcid.org/0009-0006-0134-611X 1 , Sana bouakez 1 , Thana Mahfoudhi 1 , Olfa Zoukar https://orcid.org/0000-0001-9746-3359 1 , Haifa Bergaoui 1 , Raja Faleh 1 PUBLISHED 27 Jan 2025 Author details Author details 1 Obstetrics and Gynecology Department, Faculty of Medicine, Monastir Maternity and Neonatology Centre, University of Monastir, Monastir, Monastir, 5030, Tunisia Dhekra Toumi Roles: Conceptualization, Data Curation, Methodology, Validation, Visualization, Writing – Original Draft Preparation Chayma Cheikh Mohamed Roles: Conceptualization, Investigation, Methodology, Writing – Original Draft Preparation Ahmed Hajji Roles: Conceptualization, Methodology, Writing – Original Draft Preparation Imen Ghaddab Roles: Conceptualization, Investigation, Validation, Writing – Original Draft Preparation Malak Medemagh Roles: Conceptualization, Methodology, Visualization Hanane Lazreg Roles: Conceptualization, Investigation, Methodology, Validation, Writing – Original Draft Preparation Yasmine Ben Ali Roles: Conceptualization, Investigation, Writing – Original Draft Preparation Sana Alouani Roles: Investigation, Methodology, Writing – Original Draft Preparation Jawaher Hammedi Roles: Resources, Validation, Writing – Original Draft Preparation Selma Souilah Roles: Conceptualization, Investigation, Methodology, Validation Rihab Barouni Roles: Conceptualization, Investigation, Software Hiba Ben Abdelhafidh Roles: Resources, Software, Validation, Visualization, Writing – Original Draft Preparation Sana bouakez Roles: Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation Thana Mahfoudhi Roles: Conceptualization, Investigation, Methodology, Visualization, Writing – Original Draft Preparation Olfa Zoukar Roles: Supervision, Validation, Writing – Original Draft Preparation Haifa Bergaoui Roles: Supervision, Validation, Writing – Original Draft Preparation Raja Faleh Roles: Supervision, Validation, Visualization, Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Phyllodes tumor of the breast is a rare fibroepithelial tumor, constituting less than 1% of all breast neoplasms. These tumors are characterized by rapid stromal growth and can reach significant sizes, particularly in malignant cases, necessitating aggressive surgical management due to their high recurrence risk. In this case report, we present a 40-year-old Tunisian woman diagnosed with a giant phyllodes sarcoma. The patient experienced considerable physical and psychological impacts, including impaired mobility, body image disruption, and professional limitations. Clinical examination and imaging confirmed the presence of a large lobulated mass in the left breast, with no signs of distant metastasis. A multidisciplinary team recommended a total mastectomy with immediate reconstruction using a latissimus dorsi myocutaneous flap. This approach aimed to restore breast contour while addressing both oncologic and aesthetic needs. The procedure was successful, with the excised tumor weighing 7 kg. Postoperatively, the patient received close monitoring and psychological support, emphasizing the importance of a holistic approach to recovery. This case underscores the complexities of managing giant phyllodes sarcoma, highlighting the value of a timely surgical intervention combined with effective reconstructive techniques. It also emphasizes the need for individualized treatment plans that consider both functional and aesthetic outcomes to optimize patient recovery and quality of life READ ALL READ LESS Keywords Phyllodes sarcoma , Giant breast tumor , mastectomy, Latissimus dorsi flap reconstruction, Breast oncology, Reconstructive surgery, body image, quality of life Corresponding Author(s) Chayma Cheikh Mohamed ( [email protected] ) Close Corresponding author: Chayma Cheikh Mohamed Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Toumi D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Toumi D, Cheikh Mohamed C, Hajji A et al. Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :130 ( https://doi.org/10.12688/f1000research.159059.1 ) First published: 27 Jan 2025, 14 :130 ( https://doi.org/10.12688/f1000research.159059.1 ) Latest published: 27 Jan 2025, 14 :130 ( https://doi.org/10.12688/f1000research.159059.1 ) Introduction Phyllodes sarcoma of the breast is a rare tumor, accounting for less than 1% of all breast neoplasms. 1 , 2 Characterized by rapid stromal growth, these tumors can reach considerable sizes, particularly in malignant forms, which often necessitate aggressive surgical intervention due to their high recurrence potential. 3 , 4 Although typically non-metastatic, giant phyllodes tumors pose unique challenges because of their significant size and the accompanying functional and aesthetic impacts. 5 Managing large phyllodes sarcomas generally requires a total mastectomy, often paired with immediate breast reconstruction to minimize the physical and psychological consequences for the patient. 6 , 7 The latissimus dorsi myocutaneous flap is a commonly employed technique in such cases, allowing for restoration of the breast shape using a segment of muscle, fat, and skin from the back. 8 – 11 Despite its frequent use, this procedure involves specific complexities related to tissue viability and achieving satisfactory aesthetic outcomes, particularly with exceptionally large tumors. 12 , 13 In this report, we present the case of a patient with a 7 kg giant phyllodes sarcoma, treated with a total mastectomy followed by immediate reconstruction using a latissimus dorsi flap. We explore the clinical features, therapeutic strategies, and both the functional and aesthetic results of this approach, contributing to the literature on breast oncology and reconstructive surgery. Case presentation We present the case of a 40-year-old Tunisian woman with no family history of breast cancer who had previously undergone a thyroidectomy for a benign nodule. The patient, a seamstress, reported a rapidly growing left breast mass over five months, leading to significant deformity and asymmetry, severely affecting her quality of life. Physically, the patient experienced persistent chest heaviness and pressure, limiting her ability to perform daily activities such as bending, standing, or sleeping comfortably. The tumor’s size and weight placed substantial strain on the skin, which became stretched, thinned, and erythematous, with superficial ulcerations due to skin distension and friction from clothing, causing localized pain and increasing the risk of infection. Additionally, she reported chronic thoracic pain, described as a pulling or intense pressure, worsened by movement. Psychologically, the unchecked tumor growth caused severe body image disruption, leading to a decline in self-esteem and social withdrawal due to the physical burden and the anxiety surrounding the tumor’s uncertain nature and potential malignancy. The tumor also impacted her professional life, as the weight hindered her ability to perform essential tasks, such as bending, lifting her arms, and sitting for long periods, resulting in a loss of productivity and income. Clinical examination, the tumor was well-defined, firm, and mobile, with an irregular surface and lobulated edges. The skin was erythematous and stretched, exhibiting ulcerations and an “orange peel” appearance. No axillary lymphadenopathy was detected, and there were no signs of distant metastasis ( Figure 1 ). Figure 1. Giant Phyllodes Tumor on Clinical Examination: A 40-year-old female patient presenting presents with a giant phyllodes tumor (30 × 40 cm) in the left breast, accompanied by dilated subcutaneous vessels. An initial breast ultrasound suggested the presence of proliferative mastitis in the left breast, complicated by superinfection, alongside fibrocystic changes in the right breast. A bilateral mammogram revealed a 40 × 30 cm lobulated mass in the left breast, associated with architectural distortion and asymmetry. Subsequent thoraco-abdominopelvic CT imaging identified a large tumor in the left breast, along with ipsilateral axillary lymphadenopathy, but no suspicious lesions were observed below the diaphragm. A breast biopsy was performed, confirming the histopathological diagnosis of a phyllodes sarcoma ( Figure 2 ). Figure 2. initial mammogram: (a) Oblique view, (b) Frontal view. The initial mammogram revealed a large lobulated mass in the left breast, indicating an abnormal, rounded shape with irregular contours. This mass was associated with architectural distortion. A multidisciplinary team meeting recommended a total mastectomy with 1 cm margins, given the tumor’s size and rapid growth, followed by immediate reconstruction using a latissimus dorsi flap to address the expected aesthetic and psychological impact. The procedure began with a thorough preoperative evaluation to assess the required tissue volume and ensure the viability of both donor and recipient sites. Under general anesthesia, the mastectomy was first performed, followed by an incision in the dorsal region to harvest the latissimus dorsi myocutaneous flap, carefully preserving key blood vessels. The flap was then meticulously transferred through a subcutaneous tunnel to the chest, where it was shaped and attached to restore breast volume and contour. Special attention was given to achieving aesthetic symmetry and an optimal cosmetic outcome ( Figure 3 ). Figure 3. Comprehensive procedure for latissimus dorsi myocutaneous flap harvest and transfer for breast reconstruction. (a) Comprehensive preoperative evaluation (b) Dorsal incision made to harvest the latissimus dorsi myocutaneous flap (c) Creation of a subcutaneous tunnel from the dorsal region to the chest to allow flap transfer: Careful dissection and tissue detachment to create a subcutaneous pocket, while ensuring the preservation of the flap's vascular supply. The white arrow in the image indicates the direction of the tissue dissection and the subcutaneous tunnel created to allow for the flap's passage. (d), (e) Transfer of the flap through the subcutaneous tunnel to the mastectomy bed. (f ) The donor site incision is then meticulously sutured. (g) Careful preservation of key blood vessels during flap harvest, followed by precise flap positioning on the mastectomy bed. The dashed circle in the figure indicates the preserved vascularization, while the asterisk marks the flap. (h) Shaping of the flap to restore breast volume and contour. (i) Attachment of the flap to ensure proper reconstruction. The excised tumor weighed 7 kg, and histopathological analysis reaffirmed the preoperative diagnosis of a high-grade phyllodes sarcoma ( Figure 4 ). Figure 4. Surgical specimen, tumor weighing 7 kg. Postoperatively, the patient was closely monitored to prevent complications, and daily wound care was performed to promote optimal healing. Psychological support was also provided to help her manage the emotional impact of the surgery and reconstruction, contributing to an overall improvement in her quality of life. The multidisciplinary approach, incorporating curative, reconstructive, and psychological care, was tailored to her needs as a seamstress, emphasizing the importance of a swift functional recovery. By one month post-surgery, she demonstrated improved mobility and psychological recovery. At the three-month follow-up, the patient showed no signs of recurrence or major complications, and her overall recovery had progressed well ( Figure 5 ). Figure 5. Appearance of breast reconstruction site three months post-surgery. Discussion Phyllodes tumors encompass a wide spectrum of fibroepithelial lesions, ranging from fibroadenomas to benign, borderline, and malignant phyllodes tumors, based on their histological characteristics. 14 , 15 The term “phyllodes” is derived from the Latin word “phyllodium,” meaning “leaf-like,” referring to the tumor’s gross appearance, which is characterized by a large, lobulated, leaf-like structure. 16 , 17 These tumors predominantly affect women aged 35 to 55 and are rare in adolescents or the elderly. 18 Although phyllodes tumors constitute only 0.3 to 0.5% of all breast neoplasms, with an incidence of approximately 2.1 cases per million women, they vary widely in behavior. 19 It is estimated that 85-90% of these tumors are benign, while 10-15% are malignant. 20 Giant phyllodes tumors, those exceeding 10 cm in diameter, account for around 20% of cases and carry a higher risk of malignancy. Phyllodes tumors commonly arise in the right breast, and in approximately one-third of cases, they are multicentric. These tumors often present as rapidly enlarging, painless masses that distort the breast and stretch the skin, leading to potential complications such as pressure necrosis. The rapid growth and significant size are hallmark indicators of phyllodes tumors, distinguishing them from fibroadenomas, although their clinical presentations can be similar. This classical presentation was evident in the case we observed. 21 , 22 For diagnosis, imaging techniques such as ultrasound, mammography, MRI, and core needle biopsy are employed. Among these, ultrasound and mammography are most frequently used as first-line diagnostic tools. 20 Ultrasound typically shows large, heterogeneous solid masses with lobulated margins and possible internal vascularity, while mammography reveals hyperdense masses, often occupying a significant portion of the breast. 16 , 23 , 24 Despite these findings, phyllodes tumors share imaging characteristics with fibroadenomas, making it challenging to distinguish between the two based on imaging alone. 15 Notably, phyllodes tumors do not exhibit pathognomonic features on either ultrasound or mammography. 20 Due to the size of these tumors, core needle biopsy or fine needle aspiration may not always provide a definitive diagnosis, as histological similarities between benign phyllodes tumors, fibroadenomas, and phyllodes sarcomas can complicate differentiation. 24 , 25 Excisional biopsy, with careful assessment of surgical margins, is often necessary for accurate diagnosis. 24 Total mastectomy remains the cornerstone of treatment for phyllodes sarcoma, especially when they reach significant sizes and carry a high risk of recurrence. Experts recommend excising the tumor with at least a 1 cm margin, either during initial surgery or in cases of re-excision. Axillary lymph node dissection is not typically required for non-metastatic phyllode tumors, as lymph node involvement is rare. 26 , 27 The psychological impact of mastectomy, especially following the removal of large tumors, is significant, as it can adversely affect body image and self-esteem. 28 , 29 Immediate breast reconstruction using a latissimus dorsi myocutaneous flap offers a valuable option for restoring breast contour while addressing both functional and aesthetic needs. 30 This procedure involves the transfer of muscle, fat, and skin from the back, carefully preserving the vascular pedicle to ensure blood supply. The flap is then tunneled to the chest to reconstruct the breast, and it may be combined with implants or tissue expanders to optimize cosmetic results. Postoperative care focuses on maintaining flap viability, wound healing, and restoring shoulder function, with minimal long-term functional deficits. 31 , 32 This approach effectively combines oncologic and aesthetic goals while significantly improving patients’ postoperative quality of life. Studies have highlighted the positive effects of breast reconstruction on quality of life, particularly regarding body image. This is especially true for younger women who value their physical appearance highly. Reconstruction not only helps restore physical form but also improves emotional well-being and self-esteem, facilitating a quicker return to normal activities through early mobilization and functional recovery. 33 – 36 It is essential to integrate oncologic and reconstructive approaches to ensure comprehensive care. 37 While breast reconstruction restores physical form and emotional health, adjuvant therapies, such as radiotherapy, play a critical role in reducing local recurrence rates in malignant phyllodes tumors, though they do not impact overall survival or disease-free survival. 15 Chemotherapy is not routinely used, as its benefits are unproven, limiting its use to compassionate cases. Hormonal therapy is also not recommended, despite positive hormone receptor status in up to 75% of cases. In metastatic disease, treatment protocols for soft tissue sarcomas should be followed. 15 , 38 Conclusion In conclusion, this case of a 40-year-old woman with a giant phyllodes sarcoma of the breast, successfully treated with total mastectomy and immediate latissimus dorsi flap reconstruction, illustrates the importance of a multidisciplinary approach in managing both the oncologic and aesthetic challenges posed by large tumors. This case emphasizes the need for timely surgical intervention, combined with effective reconstructive techniques, to minimize physical and psychological impacts, ensuring optimal recovery and quality of life for the patient. It also highlights the necessity of individualized treatment planning, particularly in cases where functional and aesthetic outcomes are critical. Consent Written informed consent was obtained from the patient for the publication of their clinical details and/or images. Data availability No data are associated with this article. 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Breast Surg. 30 juin 2024 [cité 31 oct 2024]; 8 : 19. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 29. Heidari M, Shahbazi S, Ghodusi M: Evaluation of body esteem and mental health in patients with breast cancer after mastectomy. J.-Life Health. déc 2015; 6 (4): 173. 30. Simion L, Petrescu I, Chitoran E, et al. : Breast Reconstruction following Mastectomy for Breast Cancer or Prophylactic Mastectomy: Therapeutic Options and Results. Life. janv 2024; 14 (1): 138. PubMed Abstract | Publisher Full Text | Free Full Text 31. Breast reconstruction with flap surgery - Mayo Clinic.[cité 31 oct 2024]. Reference Source 32. Ben Aziz M, Rose J: Breast Reconstruction Perforator Flaps. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 [cité 31 oct 2024]. Reference Source 33. Pačarić S, Orkić Ž, Babić M, et al. : Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients. Int. J. Environ. Res. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 Obstetrics and Gynecology Department, Faculty of Medicine, Monastir Maternity and Neonatology Centre, University of Monastir, Monastir, Monastir, 5030, Tunisia Dhekra Toumi Roles: Conceptualization, Data Curation, Methodology, Validation, Visualization, Writing – Original Draft Preparation Chayma Cheikh Mohamed Roles: Conceptualization, Investigation, Methodology, Writing – Original Draft Preparation Ahmed Hajji Roles: Conceptualization, Methodology, Writing – Original Draft Preparation Imen Ghaddab Roles: Conceptualization, Investigation, Validation, Writing – Original Draft Preparation Malak Medemagh Roles: Conceptualization, Methodology, Visualization Hanane Lazreg Roles: Conceptualization, Investigation, Methodology, Validation, Writing – Original Draft Preparation Yasmine Ben Ali Roles: Conceptualization, Investigation, Writing – Original Draft Preparation Sana Alouani Roles: Investigation, Methodology, Writing – Original Draft Preparation Jawaher Hammedi Roles: Resources, Validation, Writing – Original Draft Preparation Selma Souilah Roles: Conceptualization, Investigation, Methodology, Validation Rihab Barouni Roles: Conceptualization, Investigation, Software Hiba Ben Abdelhafidh Roles: Resources, Software, Validation, Visualization, Writing – Original Draft Preparation Sana bouakez Roles: Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation Thana Mahfoudhi Roles: Conceptualization, Investigation, Methodology, Visualization, Writing – Original Draft Preparation Olfa Zoukar Roles: Supervision, Validation, Writing – Original Draft Preparation Haifa Bergaoui Roles: Supervision, Validation, Writing – Original Draft Preparation Raja Faleh Roles: Supervision, Validation, Visualization, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 27 Jan 2025, 14:130 https://doi.org/10.12688/f1000research.159059.1 Copyright © 2025 Toumi D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Toumi D, Cheikh Mohamed C, Hajji A et al. Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :130 ( https://doi.org/10.12688/f1000research.159059.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 27 Jan 2025 Views 0 Cite How to cite this report: Firmani G. Reviewer Report For: Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :130 ( https://doi.org/10.5256/f1000research.174733.r370937 ) The direct URL for this report is: https://f1000research.com/articles/14-130/v1#referee-response-370937 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Mar 2025 Guido Firmani , Sapienza University Rome, Rome, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.174733.r370937 I commend the authors for their case report. This report is compelling, and the figures are convincing. I believe this is deserving of interest to the readership. However, I would appreciate if you could provide some additional information. Please see ... Continue reading READ ALL I commend the authors for their case report. This report is compelling, and the figures are convincing. I believe this is deserving of interest to the readership. However, I would appreciate if you could provide some additional information. Please see my comments listed below: Please make sure that your report abides by the SCARE checklist for case reports, which helps ensure that appropriate standards have been followed when preparing your manuscript. If this has already been done, then please acknowledge this in your manuscript. I would appreciate some added surgical details. It appears that you performed an autologous LD flap. What were the dimensions of the skin paddle you harvested? To account to differences in size between the affected side and the contralateral breast, have you considered performing a balancing procedure? Did you consider augmenting your LD volume over time with added surgical procedures? It could be viable to perform a FALD with subsequent autologous fat grafts to achieve a larger volume using the scaffolding created by the LD muscle and overlying skin paddle. [PMID: 35907690] Do you have concerns of oncologic safety regarding the utility of autologous fat grafting in breast cancer patients? Please acknowledge evidence from a case-control study on 1000 breast cancer patients which found it not to increase local recurrence rates. [PMID: 35943964] Phyllodes tumors are considered “giant” when weighing over 1 kg. Your case well exceeds that threshold and is the second heaviest report in literature, after the one reported by Dong Xia et al. [2010 (Ref-3)] (doi: 10.1007/s10330-010-0688-0) weighing 9.79 kg ex vivo! The third heaviest report was 5.4 kg. [PMID: 30034663]. Please consider addressing these reports from literature. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Santanelli di Pompeo F, D'Orsi G, Firmani G, Paolini G, et al.: Total breast reconstruction with the fat-augmented latissimus dorsi (FALD) flap: High safety in a single-center uncontrolled case series. J Plast Reconstr Aesthet Surg . 2022; 75 (9): 3004-3013 PubMed Abstract | Publisher Full Text 2. Sorotos M, Paolini G, D'Orsi G, Firmani G, et al.: Oncologic Outcome of 1000 Postmastectomy Breast Reconstructions with Fat Transfer: A Single-Center, Matched Case-Control Study. Plast Reconstr Surg . 2022; 150 : 4S-12S PubMed Abstract | Publisher Full Text 3. Xia D, Zuo H, Quan Y, Dong H, et al.: Giant phyllodes tumor of the breast: a case report. The Chinese-German Journal of Clinical Oncology . 2010; 9 (11): 674-676 Publisher Full Text 4. Albalawi IA: A huge phyllodes tumor in the breast: a case report. Electron Physician . 2018; 10 (6): 6951-6955 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Plastic surgery, breast reconstruction. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Firmani G. Reviewer Report For: Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :130 ( https://doi.org/10.5256/f1000research.174733.r370937 ) The direct URL for this report is: https://f1000research.com/articles/14-130/v1#referee-response-370937 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 27 Jan 25 read Guido Firmani , Sapienza University Rome, Rome, Italy Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Firmani G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Mar 2025 | for Version 1 Guido Firmani , Sapienza University Rome, Rome, Italy 0 Views copyright © 2025 Firmani G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I commend the authors for their case report. This report is compelling, and the figures are convincing. I believe this is deserving of interest to the readership. However, I would appreciate if you could provide some additional information. Please see my comments listed below: Please make sure that your report abides by the SCARE checklist for case reports, which helps ensure that appropriate standards have been followed when preparing your manuscript. If this has already been done, then please acknowledge this in your manuscript. I would appreciate some added surgical details. It appears that you performed an autologous LD flap. What were the dimensions of the skin paddle you harvested? To account to differences in size between the affected side and the contralateral breast, have you considered performing a balancing procedure? Did you consider augmenting your LD volume over time with added surgical procedures? It could be viable to perform a FALD with subsequent autologous fat grafts to achieve a larger volume using the scaffolding created by the LD muscle and overlying skin paddle. [PMID: 35907690] Do you have concerns of oncologic safety regarding the utility of autologous fat grafting in breast cancer patients? Please acknowledge evidence from a case-control study on 1000 breast cancer patients which found it not to increase local recurrence rates. [PMID: 35943964] Phyllodes tumors are considered “giant” when weighing over 1 kg. Your case well exceeds that threshold and is the second heaviest report in literature, after the one reported by Dong Xia et al. [2010 (Ref-3)] (doi: 10.1007/s10330-010-0688-0) weighing 9.79 kg ex vivo! The third heaviest report was 5.4 kg. [PMID: 30034663]. Please consider addressing these reports from literature. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Santanelli di Pompeo F, D'Orsi G, Firmani G, Paolini G, et al.: Total breast reconstruction with the fat-augmented latissimus dorsi (FALD) flap: High safety in a single-center uncontrolled case series. J Plast Reconstr Aesthet Surg . 2022; 75 (9): 3004-3013 PubMed Abstract | Publisher Full Text 2. Sorotos M, Paolini G, D'Orsi G, Firmani G, et al.: Oncologic Outcome of 1000 Postmastectomy Breast Reconstructions with Fat Transfer: A Single-Center, Matched Case-Control Study. Plast Reconstr Surg . 2022; 150 : 4S-12S PubMed Abstract | Publisher Full Text 3. Xia D, Zuo H, Quan Y, Dong H, et al.: Giant phyllodes tumor of the breast: a case report. The Chinese-German Journal of Clinical Oncology . 2010; 9 (11): 674-676 Publisher Full Text 4. Albalawi IA: A huge phyllodes tumor in the breast: a case report. Electron Physician . 2018; 10 (6): 6951-6955 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Plastic surgery, breast reconstruction. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Firmani G. Peer Review Report For: Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :130 ( https://doi.org/10.5256/f1000research.174733.r370937) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-130/v1#referee-response-370937 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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