Peer Review Report For: Case Report: Giant Malignant Phyllodes Tumor of the Breast: Immediate Reconstruction with a Pedicled Latissimus Dorsi Myocutaneous Flap Following Total Mastectomy—A Case Report and Review of Reconstructive Considerations [version 2; peer review: 1 approved]

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