Considerations of previous augmentation in subsequent breast reconstruction.
BACKGROUND
The number of patients receiving augmentation mammaplasty is rapidly growing. Breast cancer will develop in a significant number of these women.


OBJECTIVE
The authors report on a series (expanding the size of a previous study by the senior author, S.L.S.), encompassing one surgeon's experience performing breast reconstruction in women who had undergone previous augmentation. They compare the stage and detection method in this series with other published studies and also review their experience with regard to the benefit of subpectoral versus subglandular implant placement.


METHODS
A retrospective review of the senior author's reconstructive practice was performed, including the period from July 1983 to July 2007. Thirty-two consecutive women were identified who had previously received augmentation mammaplasty, were subsequently diagnosed with cancer, and then underwent breast reconstruction. Types of reconstructive procedures and outcomes were evaluated. A statistical analysis of the results was performed with a standard 2-tailed t test and chi(2) analysis.


RESULTS
The occurrence of breast cancer diagnosis after augmentation ranged from 1 to 25 years (mean, 15 years). No implants were ruptured at the time of mastectomy. Of the 16 patients with previous subpectoral augmentation, cancer was detected mammographically in 12 (75%). Of the 16 patients with previous subglandular augmentation, cancer was detected mammographically in 7 (44%). This difference was not statistically significant, but that may be related to the insufficient population size (P = .15). Twenty-two (69%) of the patients underwent a purely prosthetic reconstruction. Flaps were used in the other 10 (31%), including 5 (16%) latissimus dorsi flaps and 5 (16%) transverse rectus abdominis flaps. Nine (90%) of those 10 flaps were used in patients undergoing radiation therapy. There were 9 stage 0 (28.1%), 9 stage I (28.1%), 12 stage II (37.5%), and 2 stage III (6.3%) patients. Among the subglandular group, there were 5 stage 0 (31.3%), 2 stage I (12.5%), 7 stage II (43.8%), and 2 stage III (12.5%) patients. Among the subpectoral group, there were 4 stage 0 (25.0%), 7 stage I (43.8%), 5 stage II (31.3%), and no stage III or IV patients. There was no significant difference in the axillary status between the 2 implant location groups. Eleven of the total 32 (34%) patients were treated with radiation therapy. Of these patients, 2 received breast conservation therapy and the other 9 underwent mastectomy. Of the 11 augmented breasts that received radiation therapy, 9 had flaps used in their reconstruction, including 5 latissimus dorsi and 4 trans-rectus abdominis muscle flaps. The average length of follow-up for the entire group was 26.4 months (range, 1-109 months).


CONCLUSIONS
A history of breast augmentation was demonstrated to have consequences for future management of cancer in the areas of detection, cancer management, and reconstruction options. In addition, it was shown that the site of implantation may have an effect on the effectiveness of breast imaging.
Spear
Scott L
SL
Department of Plastic Surgery, Georgetown University Medical Center, Washington, DC, USA.
Clemens
Mark W
MW
Dayan
Joseph H
JH
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000379:methods*; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D010808:Physical Examination; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome