PURPOSE: This study was performed to evaluate the patterns of secondary failure, and the prognostic factors for survival, following surgical treatment of an isolated locoregional recurrence after a mastectomy in breast cancer patients. METHODS: Forty-nine patients, who had undergone an excision, or a wide excision, either with or without radiation therapy, for an isolated locoregional recurrence following a mastectomy, between 1991 and 2001, were retrospectively analyzed according to the secondary recurrence patterns, the time to the secondary failure, survival rate, and prognostic factors for survival. RESULTS: During the 33 month median follow-up, 28 patients (57%) developed a secondary recurrence; an isolated locoregional failure in 7 (25%), a systemic dissemination in 20 (71%), and both in 1 (4%). The median times from the first recurrence to the second failure, according to the pattern of the secondary failure, were 16, 14 and 6 months for locoregional, for systemic dissemination, and for both, respectively. The disease-free interval (DFI) from first surgery to the recurrence was a significant independent prognostic factor for the second failure. A Univariate analysis identified the DFI, and hormone therapy administered due to a recurrence, as significant prognostic factors for overall survival, but these were not from a multivariate analysis. The 5-year disease- free and overall survival rates for an isolated locoregional recurrence were 27% and 79%, respectively, compared with 0% for both these rates for a recurrence combined with a systemic recurrence (P=0.002). CONCLUSION: A secondary failure, following treatment of an isolated locoregional recurrence, developed in more than half the patients, with a locoregional failure in 25%, and a systemic dissemination in the remainder. DFI and hormone therapy for a recurrence were independent prognostic factors of the overall survival. The survival rates after surgical treatment of isolated locoregional recurrences were increased compared with those for a recurrence combined with a systemic recurrence.