Post-operative Findings/Recurrent Disease

Abstract

Breast cancer treatment has evolved since William Halsted, MD, an American surgeon, introduced the radical mastectomy in 1882 (Halsted, Ann Surg 20:497, 1894). The modified radical mastectomy gained popularity in the 1970s (www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-treatment-surgery. Accessed 11/23/2015) and in 1985. Fisher et al. established lumpectomy, or breast conservation therapy (BCT), and radiation as treatment for early stage breast cancers (Fisher et al., N Engl J Med 312(11):665–673, 1985). The National Institutes of Health soon endorsed and thus popularized this less invasive treatment (Consensus statement: treatment of early-stage breast cancer. National Institutes of Health Consensus Development Panel. J Natl Cancer Inst Monogr. 1992;11:1–5. Review). Today, while BCT and radiation remain the standard of care for stage I and II cancers, mastectomy and reconstruction procedures have been updated and rising ipsilateral and contralateral prophylactic mastectomy rates have been documented (Jones et al., Ann Surg Oncol 16(10):2691–2696, 2009; Tuttle et al., J Clin Oncol 25(33):5203–5209, 2007; McGuire et al., Ann Surg Oncol 16(10):2682–2690, 2009; Dragun et al., Am J Clin Oncol 36(4):375–380, 2013).

As women survive their breast cancers and continue screening with mammogram, ultrasound and often MRI, differentiating multi-modality post-operative and post-radiation changes from signs of malignancy is key both for the avoidance of unnecessary biopsies and for the early detection of subsequent cancers in this elevated risk population. In this chapter, we will cover normal post-lumpectomy and post-radiation findings on mammogram, ultrasound, and MRI and contrast these post-treatment changes with imaging features of recurrent cancers. We will also discuss mastectomy techniques, including the modified radical mastectomy and skin- and nipple-sparing mastectomies together with autologous and implant reconstructions, along with tips for avoiding common pitfalls.