A Review of the Oncologic and Surgical Management of Breast Cancer in the Augmented Breast: Diagnostic, Surgical and Surveillance Challenges
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The challenges of managing breast cancer in women with augmented breasts include screening, diagnosis, oncologic and revisional surgery, and surveillance. In addition, women with augmented breasts frequently have greater expectations of cosmetic outcomes. More breast clinicians will be affected by these challenges as augmentation grows in popularity and women with implants reach the age range in which they are at higher risk of developing breast cancer. In the United States, more than 2 million women have undergone augmentation, making this the second most commonly performed cosmetic procedure.1 With a lifetime risk of developing breast cancer of 1 in 8, it is projected that more than 50,000 women who undergo augmentation each year in the United States will develop breast cancer at some point in their lives.2
This is a review of current practice based on an exhaustive literature search of PubMed, Google Scholar, and conference proceedings. A series of case studies is presented to illustrate mammographic changes and cosmetic outcomes in augmented breasts that have required treatment for breast cancer.
An evidence-based summary of recommendations has been produced to guide breast surgeons in managing this particular group of patients.
Management of breast cancer in previously augmented breasts presents a unique range of challenges. Patients can be reassured that the presence of an implant does not increase the risk of breast cancer developing or affect the prognosis if breast cancer does develop. Clinical judgement is made balancing surgical and oncologic principles to provide the best cosmetic outcome.
- American Society for Aesthetic Plastic Surgery. Statistics on cosmetic surgery. New York: Cosmetic Surgery National Data Bank, American Society of Aesthetic Plastic Surgery Communications Office; 2007.
- American Cancer Society. Breast cancer facts and figures 2009–2010. http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final90809pdf.pdf. Accessed 11 Oct 2010.
- Berkel H, Birdsell DC, Jenkins H. Breast augmentation: a risk factor for breast cancer? N Engl J Med. 1992;326:1649–53. CrossRef
- Deapen DM, Brody GS. Augmentation mammaplasty and breast cancer: a 5-year update of the Los Angeles Study. Plast Reconstr Surg. 1992;89:660–5. CrossRef
- Deapen DM, Bernstein L, Brody GS. Are breast implants anticarcinogenic? A 14-year follow-up of the Los Angeles study. Plast Reconstr Surg. 1997;99:1346–53. CrossRef
- Deapen D. Breast implants and breast cancer: a review of incidence, detection, mortality and survival. Plast Reconstr Surg. 2007;120:705–805. CrossRef
- Brisson J, Holowaty EJ, Villeneuve PJ, Xie L, Ugnat A-M, Latulippe L, Mao Y. Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation. Int J Can. 2006;118:2854–62. CrossRef
- Lamm SH. Silicone breast implants and long-term health effects: when are data adequate? J Clin Epidemiol. 1995;48:507–11. CrossRef
- Hoshaw SJ, Klein PJ, Clark BD, Cook RR, Perkins LL. Breast implants and cancer: causation, delayed detection and survival. Plast Reconstr Surg. 2001;107:1393–407. CrossRef
- Brinton LA, Lubin JH, Burich MC, Colton T, Brown SL, Hoover RN. Breast cancer following augmentation mammoplasty (United States). Cancer Causes Control. 2000;11:819–27. CrossRef
- Friis S, McLaughlin JK, Mellemkjaer L, Kjøller KH, Blot WJ, Boice JD Jr, Fraumeni JF Jr, Olsen JH. Breast implants and cancer risk in Denmark. Int J Cancer. 1997;71:956–8. CrossRef
- Mellemkjaer L, Kjoller K, Friis S, et al. Cancer occurrence after cosmetic breast implantation in Denmark. Int J Cancer. 2000;88:301–6. CrossRef
- Friis S, Hölmich LR, McLaughlin JK, Kjøller K, Fryzek JP, Henriksen TF, Olsen JH. Cancer risk among Danish women with cosmetic breast implants. Int J Cancer. 2006;118:998–1003. CrossRef
- McLaughlin JK, Fraumeni JF Jr, Nyren O, Adami HO. Silicone breast implants and risk of cancer? JAMA. 1995;273:116. CrossRef
- McLaughlin JK, Nyrén O, Blot WJ, Yin L, Josefsson S, Fraumeni JF Jr, Adami HO. Cancer risk among women with cosmetic breast implants: a population based cohort study in Sweden. J Natl Cancer Inst. 1998;90:156–8. CrossRef
- McLaughlin JK, Lipworth L, Fryzek JP, Ye W, Tarone RE, Nyren O. Long-term cancer risks among Swedish women with cosmetic breast implant: an update of a nationwide study. J Natl Cancer Inst. 2006;98:557–60. CrossRef
- Pukkala E, Boice JD, Hovi SL, et al. Incidence of breast and other cancers among Finnish women with cosmetic breast implants. J Long-Term Eff Med Implants. 2002;12:271–9.
- Cook LS, Daling JR, Voigt LF, de Hart MP, Malone KE, Stanford JL, Weiss NS, Brinton LA, Gammon MD, Brogan D. Characteristics of women with and without breast augmentation. JAMA. 1997;277:1612–7. CrossRef
- Fryzek JP, Weiderpass E, Signorello LB, Hakelius L, Lipworth L, Blot WJ, McLaughlin JK, Nyren O. Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery patients and women in the general population of Sweden. Ann Plast Surg. 2000;45:349–56. CrossRef
- Kjoller K, Holmich LR, Fryzek JP, Jacobsen S, Bittmann S, Olsen JH. Characteristics of women with cosmetic breast implants compared with women with other types of cosmetic surgery and population-based controls in Denmark. Ann Plast Surg. 2003;50:6–12. CrossRef
- Dreyfuss DA, Singh S, Dowlatshahi K, Krizek TJ. Silicone implants as an anticarcinogen. Surg Forum. 1987;38:587–8.
- Ramasastry SS, Weinstein LW, Zerbe A, Narayanan K, LaPietra D, Futrell JW. Regression of local and distant tumor growth by tissue expansion: An experimental study of mammary carcinoma 13,762 in rats. Plast Reconstr Surg. 1991;87:1–7. CrossRef
- Su CW, Dreyfuss DA, Krizek TJ, Leoni KJ. Silicone implants and the inhibition of cancer. Plast Reconstr Surg. 1995;96:513–8. CrossRef
- Kusano AS, Trichopoulos D, Terry KL, Chen WY, Willett WC, Michels KB. A prospective study of breast size and premenopausal breast cancer incidence. Int J Cancer. 2006;118:2031–4. CrossRef
- Clark CP, Peters GN, O’Brien KM. Cancer in the augmented breast. Diagnosis and prognosis. Cancer. 1993;72:2170–4. CrossRef
- Carlson GW, Curley SA, Martin JE, Fornage BD, Ames FC. The detection of breast cancer after augmentation mammoplasty. Plast Reconstr Surg. 1993;91:837–40. CrossRef
- Raso DS, Greene WB, Kalasinsky VF, et al. Elemental analysis and clinical implications of calcification deposits associated with silicone breast implants. Ann Plast Surg. 1999;42:117–23.
- Miglioretti DL, Rutter CM, Geller BM, et al. Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 2004;291:442–50. CrossRef
- Monsees BS, Destouet JM. Mammography in aesthetic and reconstructive breast surgery. Perspect Plast Surg. 1991;5:103–19.
- Handel N, Silvestein MJ, Gamagami P, Jensen JA, Collins A. Factors affecting mammographic visualization of the breast after augmentation mammaplasty. JAMA. 1992;268:1913–7. CrossRef
- Handel N, Silverstein MJ, Gamagami P. The effect of silicone-gel-filled implants on mammography. Cancer. 1991;68:1159–63. CrossRef
- Eklund GW, Busby RC, Miller SH, Job JS. Improved imaging of the augmented breast. Am J Roentgenol. 1988;151:469–73.
- Silverstein MJ, Handel N, Gamagami P, Waisman E, Gierson ED. Mammographic measurements before and after augmentation mammaplasty. Plast Reconstr Surg. 1990;86:1126–30. CrossRef
- Skinner KA, Silberman H, Dougherty W, Gamagami P, Waisman J, Sposto R, Silverstein MJ. Breast cancer after augmentation mammoplasty. Ann Surg Oncol. 2001;8:138–44. CrossRef
- Ahn CY, DeBruhl ND, Gorczyca DP, Shaw WW, Bassett LW. Comparative silicone breast implant evaluation using mammography, sonography, and magnetic resonance imaging: experience with 59 implants. Plast Reconstr Surg. 1994;94:620–7. CrossRef
- Berg WA, Caskey CI, Hamper UM, et al. Single and double lumen silicone breast implant integrity: prospective evaluation of MR and US criteria. Radiology. 1995;197:45–52.
- Silverstein MJ, Lagios MD, Recht A, et al. Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg. 2005;201:586–97. CrossRef
- Tuli R, Flynn RA, Brill KL, Sabol JL, Usuki KY, Rosenberg AL. Diagnosis, treatment and management of breast cancer in previously augmented women. Breast J. 2006;12:343–8. CrossRef
- Lehman CD. Role of MRI in screening women at high risk of breast cancer. J Magn Reson Imaging. 2006;24:964–70. CrossRef
- Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004;351:427–47. CrossRef
- Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 2005;365:1769–78. CrossRef
- Mitnick JS, Vazquez MF, Plesser K, Pressman P, Harris MN, Roses DF. Fine needle aspiration biopsy in patients with augmentation prostheses and a palpable mass. Ann Plast Surg. 1993;31:241–4. CrossRef
- Jackman RL, Lamm RL. Stereotactic histologic biopsy in breasts with implants. Radiology. 2002;222:157–64. CrossRef
- Handel N. The effect of silicone implants on the diagnosis, prognosis and treatment of breast cancer. Plast Reconstr Surg. 2007;120:81–93. CrossRef
- Holmich LR, Mellemkjaer L, Gunnarsdottir KA, et al. Stage of breast cancer at diagnosis among women with cosmetic breast implants. Br J Cancer. 2003;88:832–8. CrossRef
- Jakub JW, Ebert MD, Cantor A, et al. Breast cancer in patients with prior augmentation: presentation, stage and lymphatic mapping. Plast Reconstr Surg. 2004;114:1737–42. CrossRef
- Cahan AC, Ashikari R, Pressman P, Cody H, Hoffman S, Sherman JE. Breast cancer after breast augmentation with silicone implants. Ann Surg Oncol. 1995;2:121–5. CrossRef
- Deapen D, Hamilton A, Bernstein L, Brody GS. Breast cancer stage at diagnosis and survival among patients with prior breast implants. Plast Reconstr Surg. 2000;105:535–40. CrossRef
- Park AJ, Black RJ, Sarhadi NS, Chetty U, Watson AC. Silicone gel-filled implants and connective tissue diseases. Plast Reconstr Surg. 1998;101:261–8. CrossRef
- Petit JY, Lê M, Rietjens M, Contesso G, Lehmann A, Mouriesse H. Does long-term exposure to gel-filled silicone implants increase the risk of relapse after breast cancer? Tumori. 1998;84:525–8.
- Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with and without breast implants. Plast Reconstr Surg. 1993;92:795–800. CrossRef
- Villeneuve PJ, Holowaty EJ, Brisson J, Xie L, Ugnat A-M, Latulippe L, Mao Y. Mortality among Canadian women with cosmetic breast implants. Am J Epidemiol. 2006;164:334–41. CrossRef
- Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32. CrossRef
- Veronesi U, Saccozzi R, Delvecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305:6–11. CrossRef
- Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312:665–73. CrossRef
- Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1989;320:822–8. CrossRef
- Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–61. CrossRef
- Holli K, Saaristo R, Isola J, Joensuu H, Hakama M. Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study. Br J Cancer. 2001;84:164–9. CrossRef
- NIH Consensus Conference. Treatment of early stage breast cancer. JAMA. 1991;265:391–5.
- Karanas YL, Leong DS, Da Lio A, Waldron K, Watson JP, Chang H, Shaw WW. Surgical treatment of breast cancer in previously augmented patients. Plast Reconstr Surg. 2003;111:1078–83. CrossRef
- Kuske RR, Schuster R, Klein E, Young L, Perez CA, Fineberg B. Radiotherapy and breast reconstruction: clinical results and dosimetry. Int J Radiat Oncol Biol Phys. 1991;21:339–46. CrossRef
- Krishnan L, Krishnan EC. Electron beam irradiation after reconstruction with silicone gel implant in breast cancer. Am J Clin Oncol. 1986;9:223–6. CrossRef
- Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: Recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930–42. CrossRef
- Vadeweyer E, Deraemaecker R. Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg. 1995; 106;56–8.
- Evans GR, Schusterman MA, Kroll SS, Miller MJ, Reece GP, Robb GL, Ainslie N. Reconstruction and the radiated breast: is there a role for implants? Plast Reconstr Surg. 1995;96:1111–5. CrossRef
- Carlson GW, Moore B, Thornton JF, Elliott M, Bolitho G. Breast cancer after augmentation mammaplasty: treatment by skin-sparing mastectomy and immediate reconstruction. Plast Reconstr Surg. 2001;107:687–92. CrossRef
- Handel N, Lewinsky B, Jensen JA, Silverstein MJ. Breast conservation therapy after augmentation mammaplasty: is it appropriate? Plast Reconstr Surg. 1996;98:1216–24. CrossRef
- Handel N, Lewinsky B, Silverstein MJ, Gordon P, Zierk K. Conservation therapy for breast cancer following augmentation mammaplasty. Plast Reconstr Surg. 1991;87:873–8. CrossRef
- Mark RJ, Zimmerman RP, Greif JM. Capsular contracture after lumpectomy and radiation therapy in patients who have undergone uncomplicated bilateral augmentation mammoplasty. Radiology. 1996;200:621–5.
- Spear SL, Slack C, Howard MA. Postmastectomy reconstruction of the previously augmented breast: diagnosis, staging, methodology, and outcome. Plast Reconstr Surg. 2001;107:1167–76. CrossRef
- Victor SJ, Brown DM, Horwitz EM, et al. Treatment outcome with radiation therapy after breast augmentation or reconstruction in patients with primary breast carcinoma. Cancer. 1998;82:1303–9. CrossRef
- Bosworth JL, Chossein NA. Limited surgery, radiotherapy in the treatment of localized breast cancer: an overview. Surg Clin N Am. 1984;64:1115–23.
- Gray RJ, Forstner-Barthell AW, Pockaj BA, Schild SE, Halyard MY. Breast-conserving therapy and sentinel lymph node biopsy are feasible in cancer patients with previous implant breast augmentation. Am J Surg. 2004;188:122–5. CrossRef
- Prado A, Andrades P, Leniz P. Implications of transaxillary breast augmentation: lifetime probability of breast cancer development and sentinel lymph node mapping interference. Aesthet Plast Surg. 2007;31:317–9. CrossRef
- Lyman GH, Guiliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20. CrossRef
- Graf RM, Canan LW Jr, Romano GG, Tolazzi AR, Cruz GA. Re: Implications of transaxillary breast augmentation: lifetime probability of breast cancer development and sentinel lymph node mapping interference. Aesthet Plast Surg. 2007;31:322–4. CrossRef
- Mottura AA, Del Castillo R. Transaxillary breast augmentation: two breast cancer patients with successful sentinel lymph node diagnosis. Aesthet Plast Surg. 2007;31:544–9. CrossRef
- Munhoz AM, Aldrighi C, Ono C, et al. The influence of subfacial transaxillary breast augmentation in axillary lymphatic drainage patterns and sentinel lymph node detection. Ann Plast Surg. 2007;58:141–9. CrossRef
- Munhoz AM, Aldrighi C, Buschpiegel C, et al. The feasibility of sentinel lymph node detection in patients with previous transaxillary implant breast augmentation: preliminary results. Aesth Plast Surg. 2005;29:163–8. CrossRef
- Shons AR. Breast cancer and augmentation mammoplasty: the preoperative consultation. Plast Reconstr Surg. 2002;109:383–5. CrossRef
- A Review of the Oncologic and Surgical Management of Breast Cancer in the Augmented Breast: Diagnostic, Surgical and Surveillance Challenges
Annals of Surgical Oncology
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