A review of breast imaging following mastectomy with or without reconstruction in an outpatient community center

Abstract

Despite developments in surgical technique, radiation treatment, and chemotherapeutic agents, tumor recurrence and distant disease have remained a major concern in breast cancer management. Breast imaging after mastectomy in the screening arena remains a controversial topic for breast imagers. Many feel the yield of finding a recurrent cancer with imaging in the asymptomatic patient is too low to be beneficial; others believe imaging should be performed on these patients as the risk of recurrence exists. Patients after a mastectomy procedure are considered high risk and, when they present with clinical symptoms, will require evaluation by the radiologist. In this diagnostic/symptomatic scenario, imaging becomes the routine and current imaging tools, such as mammography, ultrasound, and magnetic resonance imaging (MRI), can easily be incorporated to diagnose recurrent cancer. Our facility has a large population of patients that undergo mastectomy after a carcinoma diagnosis as well as a number of patients that have undergone a mastectomy procedure because of their high-risk status (whether family history or genetic predisposition). A certain percentage of these patients have proceeded to reconstructive surgery. We image these patients routinely as part of our screening protocol. Over the years we have become familiar with the appearance of remaining tissue along the chest wall after mastectomy as well as the reconstructed breasts. This familiarity is important as the imaging of these patients with mammography and other modalities available today can be challenging. This manuscript will discuss the benefits and some limitations surrounding imaging these patients, in both the asymptomatic and symptomatic scenarios, as well as what imaging protocols can be integrated within a facility's standard evaluation.

Local recurrence following mastectomy and autologous breast reconstruction: incidence, risk factors, and management

“…This pattern of detection was exactly the same as several other studies;12,17,18 however, inconclusively, the gold standard for the diagnosis of LR remains needle cytology or excision biopsy. The outcome strongly confirmed the primary importance of physical examination in the surveillance of LR for this specific target population of patients undergoing post-MST ABR, even though mammography, ultrasound, and magnetic resonance imaging may have advantages over physical examination under some circumstances 19–21. On the other hand, it implied that the presence of flaps didn’t delay the detection of recurrent lesions, which was also consistent with conclusions in previous studies 6,14…”

Current Approaches and Challenges in Monitoring Treatment Responses in Breast Cancer

“…There are no definitive guidelines for surveillance in patients treated by mastectomy with or without reconstruction. Chest wall recurrence in mastectomy patients is between 5% and 30% 28, 29. Case reports and retrospective reviews demonstrate that local recurrence can be detected by surveillance mammography in women with breast reconstruction following mastectomy, but no clear evidence exists to support or discourage routine imaging surveillance in this particular patient population 28-30.…”

Current Approaches and Challenges in Early Detection of Breast Cancer Recurrence

“…There are no definitive guidelines for surveillance in patients treated by mastectomy with or without reconstruction. Chest wall recurrence in mastectomy patients is between 5% and 30% 59, 61. Case reports and retrospective reviews demonstrate that local recurrence can be detected by surveillance mammography in women with breast reconstruction following mastectomy, but no clear evidence exists to support or discourage routine imaging surveillance in this particular patient population 59, 61, 65.…”