Complications and Recurrence in Implant-Sparing Oncologic Breast Surgery.
BACKGROUND
Patients with a history of prior breast augmentation and newly diagnosed breast cancer represent a rapidly expanding and unique subset of patients. Prior studies have described changes in breast parenchyma and characteristic body habitus of previously augmented patients, as well as increased rates of capsular contracture associated with breast conservation therapy. In our current study, we aimed to study the risk factors contributing to morbidity and whether recurrence rates are higher in patients with prior breast augmentation undergoing lumpectomy or mastectomy for breast cancer and identify differences in complications between these 2 groups.


METHODS
Retrospective analysis approved by institutional review board was performed on patients with prior breast augmentation undergoing lumpectomy (N = 52) and mastectomy (N = 64) for breast cancer.


RESULTS
Patients with prior breast augmentation undergoing mastectomy had a higher rate of complications compared with those undergoing lumpectomy (20.3% vs 5.9% respectively, P = 0.031), after adjusting for patient-specific factors including body mass index [odds ratio (OR), 0.242; 95% confidence interval (CI), 0.063-0.922; P = 0.0376], tumor stage (OR, 0.257; 95% CI, 0.064-1.036; P = 0.0562), smoking status (OR, 0.244; 95% CI, 0.065-0.918; P = 0.0370), and chemotherapy (OR, 0.242; 95% CI, 0.064-0.914; P = 0.0364). Four patients (7.7%) developed late complications in the lumpectomy group with 2 developing capsular contractures, 1 had fat necrosis and 1 needed complex reconstruction because of flattening of the nipple-areolar complex. There was no difference in recurrence or tumor margins between lumpectomy and mastectomy groups.


CONCLUSIONS
Patients with prior breast augmentation undergoing mastectomy have higher complication rates compared with lumpectomy even after adjusting for tumor stage. There appears to be no increased oncologic risk associated with either procedure given our current follow-up. Understanding these operative risks may help in patients' decision-making process with regards to type of oncologic surgery.
From the *Division of Plastic Surgery Residency Program, USF Health, University of South Florida; and †Division of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Joshua B
JB
Elston
Sangeetha
S
Prabhakaran
Amina
A
Lleshi
Brianna
B
Castillo
Weihong
W
Sun
Ambuj
A
Kumar
Zhenjun
Z
Ma
Paul D
PD
Smith
Deniz
D
Dayicioglu
D000328:Adult; D000367:Age Factors; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000379:methods* / Q000401:mortality; D015412:Mastectomy, Segmental / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D016017:Odds Ratio; D059351:Organ Sparing Treatments / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis