Breast Cancer in the Previously Augmented Breast

Abstract

Breast cancer in a previously augmented breast raises questions regarding cancer detection and staging, surgical and adjuvant treatment options, reconstructive outcomes, management of the contralateral breast, and continued breast cancer surveillance. This article explores the oncologic and reconstructive issues relevant to women desiring cosmetic breast implants and women with breast cancer who have undergone prior cosmetic breast augmentation.

Immediate Breast Reconstruction Using Silicone Implants in Previously Augmented Patients

“…Generally, two surgical treatments are available for removing the tumor in previously augmented patients: breast-conserving surgery and mastectomy [4]. According to Singh et al [8], patients who have undergone augmentation mammoplasty are not ideal candidates for breast-conserving surgery owing to its small breast size, and may experience distortion after lumpectomy.…”

“…Patients who have undergone breast augmentation commonly have a low body mass index (BMI), lesser lower abdominal and back tissue limits in harvesting autologous tissues [4]. Meanwhile, skin-sparing mastectomy enables immediate implant-based breast reconstruction.…”

Subpeitoral ou subglandular: qual é a melhor localização do implante para pacientes com hipomastia?

“…Several studies found that the placement of the implant under the pectoralis major allows better visualization and a larger amount of mammary parenchyma to be examined compared to placement of the implant at the subglandular location, regardless of breast size and type of implant [13][14][15] . Therefore, in patients with a strong family history of breast cancer, it is prudent to avoid using the subglandular plane.…”

Breast augmentation surgery: Clinical considerations

“…As an aside, submuscular implant placement may interfere less with screening mammography than subglandular implants do. 14,24 Current FDA recommendations to detect implant rupture encourage women with silicone breast implants to undergo screening 3 years after implantation and then every 2 years thereafter; no long-term monitoring is suggested for saline implants. 15 Many plastic surgeons evaluate silicone breast implant patients every 1 to 2 years for contracture and rupture.…”

“…Although they do not necessarily impair mastectomy or breast reconstruction, they may result in an increased rate of revision surgery after breast conservation therapy. 24,36 Mammography remains the standard of care for radiologic diagnosis but can be further supported by MRI and ultrasonography if necessary in patients with implants.…”