Diagnosis, Treatment, and Management of Breast Cancer in Previously Augmented Women

Abstract

Augmentation mammaplasty is rapidly becoming one of the most frequently performed cosmetic surgeries. However, as the augmented patient population ages, major concerns associated with the screening, diagnosis and treatment of breast cancer are being realized. Although current evidence convincingly indicates that breast implants do not play a role in inducing localized or systemic disease, particularly breast cancer, recent studies have shown implants not only reduce the sensitivity of mammography, but interfere with mammographic detection, possibly leading to delayed breast cancer diagnosis. In addition, the risk for local recurrence, as well as unfavorable cosmetic results, breast fibrosis, and capsular contracture following radiation therapy as part of breast-conserving therapy in previously augmented patients are of great concern. Given the overall lack of treatment consensus, paucity of literature, and increasing number of augmented breast cancer patients, we provide a retrospective review of the diagnosis, treatment, and follow-up of 12 augmented patients from 1998 to 2004 who developed breast cancer. Eight of 12 augmented patients presented with a palpable mass on physical examination, which prompted further mammographic evaluation. Abnormalities in the remaining four individuals were detected on routine mammographic screening. Pathology staging results were available for all 12 patients. Breast-conserving therapy was used to treat six patients and adequate negative pathologic margins were obtained in all patients. The remaining six patients were treated with mastectomy due to multifocal disease, inadequate margins, or proximity to the implant capsule. Thus far, one patient has had local recurrence and one patient has had distant recurrence after initial surgery. No evidence of local or systemic recurrence, infection, contracture, poor cosmetic outcome, or other complications has been detected in the remaining 10 patients as of the most recent follow-up. Based on this small cohort of augmented women, the presence of implants led to an increased proportion of palpable tumors, in spite of routine screening mammography. Consistent with other studies, although our results suggest a tendency toward delayed diagnosis in augmented women relative to age-matched controls, this did not appear to influence the overall prognosis.

Do Breast Implants Adversely Affect Prognosis among Those Subsequently Diagnosed with Breast Cancer? Findings from an Extended Follow-Up of a Canadian Cohort

“…In addition to our previous report, 2 publications by Silverstein and colleagues reported that breast implant women presented with more advanced stage at breast cancer diagnosis when compared with nonaugmented women (19,20). Although not statistically significant, several studies showed a tendency toward advanced breast tumors at diagnosis for women who received augmentation mammaplasty (6,(29)(30)(31)(32)(33)(34)(35). However, several other publications found little or no evidence that implant women were diagnosed at a later stage (9,12,(22)(23)(24)(25)(26)(27)(28)57).…”

“…Only 3 publications, including our previous report, showed a statistically significant shift toward more advanced breast tumors at diagnosis among augmented women (19)(20)(21). However, several other publications reported no statistically significant differences in breast cancer stage at diagnosis comparing augmented to nonaugmented women (6,9,12,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Furthermore, specific implant characteristics such as implant volume and placement might affect the detection of breast cancer (36).…”

Immediate Breast Reconstruction Using Silicone Implants in Previously Augmented Patients

“…Irrespectively, the number of breast cancer cases is increasing; in South Korea, there were 16,967 patients with breast cancer in 2011, which was a 4-fold increase compared to the number of patients in 1996. This indicates that the possibility of developing breast cancer is increasing in patients who have undergone breast augmentation [6].…”

Breast Reconstruction after Mastectomy

“…[59][60][61][62] Surveillance of a reconstructed breast is also a collaborative effort on the part of the patient and her surgeon, the medical or radiation oncologist, and the primary physician. The goal of self-examination of the reconstructed breast, like examination of the normal breast, is to detect an area that feels different to the examining fi ngers or looks different in the mirror.…”