Breast Cancer

, Volume 18, Issue 4, pp 259–267 | Cite as

A review of breast imaging following mastectomy with or without reconstruction in an outpatient community center

  • Stamatia Destounis
  • Renee Morgan
  • Andrea Arieno
  • Posy Seifert
  • Patricia Somerville
  • Philip Murphy
Review Article

Abstract

Despite developments in surgical technique, radiation treatment, and chemotherapeutic agents, tumor recurrence and distant disease have remained a major concern in breast cancer management. Breast imaging after mastectomy in the screening arena remains a controversial topic for breast imagers. Many feel the yield of finding a recurrent cancer with imaging in the asymptomatic patient is too low to be beneficial; others believe imaging should be performed on these patients as the risk of recurrence exists. Patients after a mastectomy procedure are considered high risk and, when they present with clinical symptoms, will require evaluation by the radiologist. In this diagnostic/symptomatic scenario, imaging becomes the routine and current imaging tools, such as mammography, ultrasound, and magnetic resonance imaging (MRI), can easily be incorporated to diagnose recurrent cancer. Our facility has a large population of patients that undergo mastectomy after a carcinoma diagnosis as well as a number of patients that have undergone a mastectomy procedure because of their high-risk status (whether family history or genetic predisposition). A certain percentage of these patients have proceeded to reconstructive surgery. We image these patients routinely as part of our screening protocol. Over the years we have become familiar with the appearance of remaining tissue along the chest wall after mastectomy as well as the reconstructed breasts. This familiarity is important as the imaging of these patients with mammography and other modalities available today can be challenging. This manuscript will discuss the benefits and some limitations surrounding imaging these patients, in both the asymptomatic and symptomatic scenarios, as well as what imaging protocols can be integrated within a facility’s standard evaluation.

Keywords

Mastectomy Breast Ultrasound MRI Local recurrence Breast reconstruction 

References

  1. 1.
    National Institute of Health. http://www.nih.gov. Accessed 7 Oct 2010.
  2. 2.
    Harris J, Morrow M. Treatment of early stage breast cancer. In: Harris J, Lippman M, Morrow M, Hellman S, editors. Diseases of the breast. Philadelphia: Lippincott-Raven; 1996. p. 487–547.Google Scholar
  3. 3.
    Singh N. Reconstructive breast implantation after mastectomy for breast cancer-invited critique. Arch Surg. 2005;140:1160–1.CrossRefGoogle Scholar
  4. 4.
    Bondurant S, Ernster V, Herdman R, editors. Safety of silicone breast implants (report of the Committee on the Safety of Silicone Breast Implants, Division of Health Promotion and Disease Prevention, Institute of Medicine). Washington, DC: National Academy Press; 2000.Google Scholar
  5. 5.
    Hoshaw SJ, Klein PJ, Clark BD, Cook R, Perkins L. Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg. 2001;107:1393–407.PubMedCrossRefGoogle Scholar
  6. 6.
    Le G, O’Malley C, Glaser S, Lynch C, Stanford J, Keegan T, et al. Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival. Breast Cancer Res. 2005;7:184–93.CrossRefGoogle Scholar
  7. 7.
    Glynn C, Litherland J. Imaging breast augmentation and reconstruction. BJR. 2008;81:587–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Mund DF, Wolfson P, Gorczyca DP, Fu YS, Love SM, Bassett LW. Mammographically detected recurrent nonpalpable carcinoma developing in a transverse rectus abdominis myocutaneous flap. Cancer. 1994;74:2804–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Hunt KK, Baldwin BJ, Strom EA, Ames FC, McNeese MD, Kroll SS, et al. Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction. Ann Surg Oncol. 1997;4(5):377–84.PubMedCrossRefGoogle Scholar
  10. 10.
    Helvie MA, Wilson TE, Roubidoux MA, Wilkins EG, Chang AE. Mammographic appearance of recurrent breast carcinoma with TRAM flap breast reconstructions. Radiology. 1998;209:711–5.PubMedGoogle Scholar
  11. 11.
    Helvie M, Bailey J, Roubidoux M, Pass H, Chang A, Pierce L, et al. Mammographic screening of TRAM flap breast reconstructions for detection of non-palpable recurrent cancer. Radiology. 2002;224:211–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Hogge J, Zuurbier R, de Parades E. Mammography of autologous myocurtaneous flaps. RadioGraphics. 1999;19:S63–72.PubMedGoogle Scholar
  13. 13.
    Leibman A, Styblo T, Bostwick J. Mammography of the postreconstruction breast. Plast Reconstr Surg. 1997;99(3):698–704.PubMedCrossRefGoogle Scholar
  14. 14.
    Chung S, Shin S, Chen Z, Rosen PP. Recurrent breast carcinoma arising in a transverse rectus adbominis myocutaneous flap. Arch Pathol Lab Med. 2004;128:1157–60.PubMedGoogle Scholar
  15. 15.
    Winchester D, Cox J. Standards for diagnosis and management of invasive breast carcinoma. CA Cancer J Clin. 1998;48:83–107.PubMedCrossRefGoogle Scholar
  16. 16.
    Horton J. Follow-up of breast cancer patients. Cancer. 1984;53:790–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Marrazzo A, Solina G, Puccia V, Fiorentino E, Bazan P. Evaluation of routine follow-up after surgery for breast carcinoma. J Surg Oncol. 1986;23(3):179–81.CrossRefGoogle Scholar
  18. 18.
    Ormiston MC, Timoney AG, Qureshi AR. Is follow up of patients after surgery for breast cancer worthwhile? J R Soc Med. 1985;5:62–7.Google Scholar
  19. 19.
    Fisher B, Jeong JH, Anderson S, Bryant J, Fisher E, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–75.PubMedCrossRefGoogle Scholar
  20. 20.
    Winchester DP, Sener SF, Khanderkar JD, Oviedo M, Cunningham M, Caprini J, et al. Symptomatology as an indicator of recurrent or metastatic breast cancer. Cancer. 1979;43:956–60.PubMedCrossRefGoogle Scholar
  21. 21.
    Eidelman Y, Liebling RW, Buchbinder S, Strauch B, Goldstein RD. Mammography in the evaluation of masses in breast reconstructed with TRAM flaps. Ann Plast Surg. 1998;41:229–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Yilmaz MH, Esen G, Ayarcan Y, Aydogan F, Ozguroglu M, Demir G, et al. The role of US and MR imaging in detecting local chest wall tumor recurrence after mastectomy. Diagn Interv Radiol. 2007;13:13–8.PubMedGoogle Scholar
  23. 23.
    Rissanen TJ, Makarainen HP, Mattila SI, Lindholm E, Heikkinen M, Kiviniemi H, et al. Breast cancer recurrence after mastectomy: diagnosis with mammography and US. Radiology. 1993;188:463–7.PubMedGoogle Scholar
  24. 24.
    Fajardo L, Roberts C, Hunt RK. Mammographic surveillance of breast cancer patients: should the mastectomy site be imaged? AJR. 1993;161:953–5.PubMedGoogle Scholar
  25. 25.
    Eklund GW, Cardenosa G. The art of mammographic positioning. Radiol Clin N Am. 1992;30(1):21–53.PubMedGoogle Scholar
  26. 26.
    Kalish G, DeMartini W, Peacock S, Gutierrez R, Lehman C. Screening MRI for high risk women: should patients with a treated personal history of breast cancer be screened? RSNA 2010: 96th scientific assembly and annual meeting. 2010 Nov 28–Dec 3; Chicago, USA. (abstract SSA01-01).Google Scholar
  27. 27.
    Destounis S, Arieno A, Somerville P, Seifert P, Murphy P, Morgan R, et al. Community-based practice experience of unsuspected breast magnetic resonance imaging abnormalities evaluated with second-look sonography. J Ultrasound Med. 2009;28:1337–46.PubMedGoogle Scholar
  28. 28.
    Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames F. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol. 1997;4(3):193–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Uematsu T. Screening and diagnosis of breast cancer in augmented women. Breast Cancer. 2008;15:159–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Eklund GW, Busby RC, Miller SH, Job JS. Improved imaging of the augmented breast. Am J Roentgenol. 1988;151:469–73.Google Scholar
  31. 31.
    Fajardo LL, Harvey JA, McAleese KA, Roberts CC, Granstrom P. Breast cancer diagnosis in women with subglandular silicone gel filled augmentation implants. Radiology. 1995;194:859–62.PubMedGoogle Scholar
  32. 32.
    Rubin E, Destounis SV. Imaging considerations in plastic surgery of the breast. In: Grotting JC, editor. Reoperative aesthetic and reconstructive plastic surgery, chapt 38, vol II, 2nd ed. St. Louis: Quality Medical; 2007. pp 1481–1508.Google Scholar
  33. 33.
    Kroll SS, Gherardini G, Martin JE, et al. Fat necrosis in free and pedicled TRAM flaps. Plast Reconstr Surg. 1998;102:1502–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Fat necrosis of the breast. http://www.health.am/site_tools/phprint.php. Accessed 7 Oct 2010.
  35. 35.
    Taboada J, Stephens T, Krishnamurthy S, Brandt K, Whitman G. The many faces of fat necrosis in the breast. AJR. 2009;192:815–25.PubMedCrossRefGoogle Scholar
  36. 36.
    Daly CP, Jaeger B, Sill D. Variable appearances of fat necrosis on breast MRI. AJR. 2008;191:1374–80.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2011

Authors and Affiliations

  • Stamatia Destounis
    • 1
  • Renee Morgan
    • 1
  • Andrea Arieno
    • 1
  • Posy Seifert
    • 1
  • Patricia Somerville
    • 1
  • Philip Murphy
    • 1
  1. 1.Elizabeth Wende Breast Care, LLCRochesterUSA

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