Locally Advanced Breast Cancer Cases. Case Study A: Treatment of locally advanced breast cancer with rectus abdominis flap. Elderly female presenting with large locally advanced breast cancer on the left. This patient was initially treated with chemotherapy with approximately 80 percent reduction in tumor size. Apr 12, · Locally advanced breast cancer is further divided into “operable” or “inoperable” based on the probability of achieving negative margins on histopathologic examination after an initial surgical approach that would provide long-term reduction in locoregional recurrence. Locally advanced breast cancer represents a heterogeneous collection of disease. Some are neglected primaries that have slowly progressed to an advanced stage whereas others result from rapid disease growth as a result of an aggressive biology.