Comment on ‘Morphea of the breast. Two case reports and discussion of the literature’

I have read with great interest the paper of Dancey et al. entitled ‘Morphea of the breast. Two case reports and discussion of the literature’ published in October 2006 in the Journal of Plastic, Reconstructive and Aesthetic Surgery. It reported two cases of localised scleroderma of the breast. In the first case there was no history of dermatological problems or precipitating factors. The patient underwent bilateral breast reduction and she remained disease free at 6 months follow up. The second patient developed the morphea following radiotherapy, but she decided to delay treatment. The authors showed a good result in the first case, but the same operation on the second patient would not be possible. I agree with the authors that no effective medical treatments exist for morphea, but there is another surgical option for selected cases. We reported a case of a 36 year-old woman affected, since childhood, by a localised area of scleroderma of the left chest wall at the level of the fifth rib. Growth was unaffected until the onset of puberty and breast development, when a biopsy of the left chest wall confirmed the diagnosis of scleroderma. Subsequently the right breast continued to develop normally but the left breast had arrested growth of the inferior pole, resulting in the nipple being stuck to the chest wall at the inframammary crease and, therefore, gross breast asymmetry. When normal skin is grafted on to a recipient site involved in scleroderma, it becomes morphea-like over a period of 6 to 9 months, but skin involved in scleroderma when grafted to a healthy recipient site becomes normal. ^,  However, transfer of free tissue is entirely unpredictable as there were no reports in the literature describing the use of free flaps into areas affected by scleroderma. In our case, almost 4 years after surgery there are no detectable changes in the DIEP flap. We believe that in selected cases, when surgery with local flaps is not possible, free tissue transfer is safe, reliable and will treat the disease.