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Breast conservation may be offered to women with prior augmentation mammoplasty when selected appropriately
Augmentation
mammoplasty is rapidly becoming the most frequently performed cosmetic
surgery, with more than 250,000 procedures performed annually. This study
is intended to evaluate treatment options and outcome for women with prior
augmentation mammoplasty who are subsequently diagnosed with breast cancer,
with particular attention to those undergoing breast conservation therapy.
Some concerns addressed in this study include detection, method of
evaluating extent of disease, cosmetic result, and rate of local and
systemic recurrence. In this retrospective review form 1998 to 2004, the
cancer treatment of 12 previously augmented patients were evaluated. In
eight of the 12 women, a palpable abnormality prompted further studies
leading to the diagnosis of breast cancer, while four patients presented
with an abnormal screening mammogram. Lumpectomy was performed in six of
the women with complete excision and negative margins attained. In the
remaining six women, mastectomy was performed due to multifocal disease,
inadequate margins, or close proximity to the implant capsule. The six
women undergoing breast conservation followed by whole breast radiation
(4500 to 5040 cGy in average 27 fractions with boost 1200 cGy in 6
fractions), maintained favorable cosmetic result with no implant or
radiation related complications. With an average follow up of 45 months,
one patient has had a local recurrence following treatment and one patient
diagnosed with systemic recurrence. While the study population is small, these results are encouraging in that breast conservation may be offered to women with prior augmentation mammoplasty when selected appropriately. Breast MRI may play an important role in determining eligibility for breast conservation with greater sensitivity in identifying multifocal disease, extent of disease and proximity to the implant capsule. These data also indicate that radiation in the augmented breast is effective and well tolerated with a very acceptable cosmetic result and low recurrence rate.
Bibliographic reference:
Kristin L Brill Department
of Surgery, Thomas Jefferson University Hospital, Philadelphia,
Pennsylvania, USA
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