Surgical Treatment of Breast Cancer in Previously Augmented Patients

Abstract

The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated. The surgical treatment of these patients is controversial, with several questions remaining unanswered. Is breast conservation therapy feasible in this patient population and can these patients retain their implants? A retrospective review of all breast cancer patients with a history of previous augmentation mammaplasty who were treated at the Revlon/UCLA Breast Center between 1991 and 2001 was performed. During the study period, 58 patients were treated. Thirty patients (52 percent) were treated with a modified radical mastectomy with implant removal. Twenty-eight patients (48 percent) underwent breast conservation therapy, which consisted of lumpectomy, axillary lymph node dissection, and radiotherapy. Twenty-two of the patients who underwent breast conservation therapy initially retained their implants. Eleven of those 22 patients (50 percent) ultimately required completion mastectomies with implant removal because of implant complications (two patients), local recurrences (five patients), or the inability to obtain negative margins (four patients). Nine additional patients experienced complications resulting from their implants, including contracture, erosion, pain, and rupture. The data illustrate that breast conservation therapy with maintenance of the implant is not ideal for the majority of augmented patients. Breast conservation therapy with explantation and mastopexy might be appropriate for rare patients with large volumes of native breast tissue. Mastectomy with immediate reconstruction might be a more suitable choice for these patients.

Fat Grafting to the Breast Revisited: Safety and Efficacy

“…66 -69 Radiotherapy is a critical component of breast conservation treatment to reduce the incidence of local recurrence. 67,70,71 Unfortunately, radiotherapy of a breast with an implant remarkably increases the incidence of breast capsular contracture, infection, extrusion, and poor cosmetic result. 67,69,[72][73][74][75] With further studies and experience, fat grafting to the breast may provide a safer option for our patients than breast implants in terms of both cancer detection and cancer treatment.…”

Breast Cancer in the Previously Augmented Breast

“…Karanas et al demonstrated that at the time of cancer diagnosis in 58 women with breast implants, native breast tissue constituted less than 50 percent of the overall breast volume. 42 Their group suggested that these small breast tissue volumes were easily deformed by a lumpectomy, resulting in an unacceptable cosmetic outcome. In addition, obtaining tumor-free margins was more difficult.…”

Breast cancer risk in women treated with augmentation mammoplasty (Review)

“…Although breast conserving therapy may appear aesthetically satisfying, many severe implant distortions and postoperative radiotherapy complications can occur. Modified radical mastectomy with immediate reconstruction may achieve superior aesthetic results (11,19,21,22).…”