Management of Benign Cystosarcoma Phyllodes

To the Editor.—  I write with reference to the trinity referral regarding "Management of Benign Cystosarcoma Phyllodes," published in QUESTIONS AND ANSWERS (240:1280, 1978). Donald Levitt, MD, condemns the suggestion for a bilateral subcutaneous mastectomy as being neither a good solution for benign cystosarcoma phyllodes nor an adequate treatment for a malignant tumor, and Wende Logan, MD, concurs. Yet, a specific type of subcutaneous mastectomy, which need not be bilateral, has been developed. It has been reported,¹ used, and proved efficacious in the treatment of this disease for some years in the hands of competent surgeons. A more recent study, "Total Glandular Mastectomy," was published in a recent issue of the Journal of Plastic and Reconstructive Surgery (62:167-172, 1978).It has been difficult to follow recurrence of cystosarcoma phyllodes by palpation and by mammograms or xeromammograms. Because total glandular mastectomy removes all but the skin and subcutaneous tissue, it is