title: 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.
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Tuli
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Flynn
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Brill
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sabol
authors.forename: Kenneth Y
authors.initials: KY
authors.lastname: Usuki
authors.forename: Anne L
authors.initials: AL
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D016022:Case-Control Studies; D020878:Device Removal; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome