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Hu L, Qian B, Yan Z, Bing K, Mei L, Qu X. Case report and literature review: Malignant adenomyoepithelioma after breast augmentation. Front Surg 2022; 9:981045. [PMID: 36311924 PMCID: PMC9606651 DOI: 10.3389/fsurg.2022.981045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022] Open
Abstract
Background Breast malignant adenomyoepithelioma (MAME) after breast augmentation has never been reported. Case summary We reported a case of a 55-year-old woman who was diagnosed with breast MAME 16 years after breast augmentation. Breast augmentation was performed on the patient with two 200 ml round textured prostheses in the subpectoral plane through axillary incisions in 2004. However, a breast ultrasound in 2020 revealed a suspicious malignant lump in the right breast, which was finally confirmed as MAME by pathology. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation were performed. Subsequently, the patient received three cycles of chemotherapy with the regimen of anthracycline and cyclophosphamide. In the following nearly 2 years of follow-up, no tumor recurrence and metastasis were found, and the overall treatment was satisfactory for the patient. Conclusion Here, we present a unique case in which a patient was diagnosed with breast MAME after breast augmentation. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation are feasible approaches that yield at least short-term oncological safety and acceptable aesthetic results. However, whether there is a potential relationship between MAME and breast implants remains to be further explored. Meanwhile, due to the rarity of breast MAME, more authoritative strategies considering both oncological safety and aesthetics to seek better long-term therapeutic effects are needed.
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Affiliation(s)
- Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bei Qian
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhecheng Yan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaijian Bing
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Mei
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Li Mei Xincai Qu
| | - Xincai Qu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Li Mei Xincai Qu
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Implant-Based Reconstruction following Mastectomy in Patients Who Have Had a Previous Breast Augmentation: Lessons from the National Multicenter Implant Breast Reconstruction Evaluation Study. Plast Reconstr Surg 2022; 149:324-337. [PMID: 35077406 DOI: 10.1097/prs.0000000000008713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast augmentation is the most commonly performed cosmetic procedure, and increasingly women in this group present with breast cancer or request risk-reducing surgery, but their optimal management is unclear. The authors explored the clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction following previous augmentation and compared these with outcomes of patients who had not had cosmetic implants in the Implant Breast Reconstruction Evaluation (iBRA) Study. METHODS Patients undergoing immediate implant-based breast reconstruction were prospectively recruited from breast and plastic surgical units across the United Kingdom. Demographic, operative, and oncologic data, and information regarding complications within 3 postoperative months were collected. Patient-reported outcomes at 18 months were assessed using the BREAST-Q. The clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction with and without previous breast augmentation were compared. RESULTS A total of 2108 women were included in the iBRA Study, of whom 49 had undergone a previous augmentation. Women in the augmentation group were younger (median age, 45 years versus 50 years; p = 0.01), had a lower body mass index (22.8 kg/m2 versus 24.9 kg/m2; p < 0.01), and had smaller tumors (15 mm versus 25 mm; p = 0.01) than patients without augmentation. No differences were seen in operative technique between the groups. Complications at 3 months were similar in both groups and there were no significant differences in patient-reported outcomes at 18 months. CONCLUSIONS The clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction following previous augmentation are consistent with those observed in the wider iBRA Study cohort, supporting the safety of this approach.
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Deandrea S, Cavazzana L, Principi N, Luconi E, Campoleoni M, Bastiampillai AJ, Bracchi L, Bucchi L, Pedilarco S, Piscitelli A, Sfondrini MS, Silvestri AR, Castaldi S. Screening of women with aesthetic prostheses in dedicated sessions of a population-based breast cancer screening programme. LA RADIOLOGIA MEDICA 2021; 126:946-955. [PMID: 33954896 PMCID: PMC8206050 DOI: 10.1007/s11547-021-01357-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed. MATERIALS AND METHODS The study was conducted in a screening centre in Milan in the years 2009-2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination. RESULTS A total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time. CONCLUSIONS Screening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes.
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Affiliation(s)
- Silvia Deandrea
- Health Protection Agency Metropolitan City of Milan, Milan, Italy
| | - Laura Cavazzana
- Post Graduate School of Public Health, University of Milan, Milan, Italy.
| | - Niccolò Principi
- Post Graduate School of Public Health, University of Milan, Milan, Italy
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Campoleoni
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lucia Bracchi
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori, IRST, "Dino Amadori"), Meldola, Forlì, Italy
| | - Stella Pedilarco
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Piscitelli
- Post Graduate School of Public Health, University of Milan, Milan, Italy
| | - Maria Silvia Sfondrini
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Cohen EO, Perry RE, Tso HH, Phalak KA, Lesslie MD, Gerlach KE, Sun J, Srinivasan A, Leung JWT. Breast cancer screening in women with and without implants: retrospective study comparing digital mammography to digital mammography combined with digital breast tomosynthesis. Eur Radiol 2021; 31:9499-9510. [PMID: 34014380 DOI: 10.1007/s00330-021-08040-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Compare four groups being screened: women without breast implants undergoing digital mammography (DM), women without breast implants undergoing DM with digital breast tomosynthesis (DM/DBT), women with implants undergoing DM, and women with implants undergoing DM/DBT. METHODS Mammograms from February 2011 to March 2017 were retrospectively reviewed after 13,201 were excluded for a unilateral implant or prior breast cancer. Patients had been allowed to choose between DM and DM/DBT screening. Mammography performance metrics were compared using chi-square tests. RESULTS Six thousand forty-one women with implants and 91,550 women without implants were included. In mammograms without implants, DM (n = 113,973) and DM/DBT (n = 61,896) yielded recall rates (RRs) of 8.53% and 6.79% (9726/113,973 and 4204/61,896, respectively, p < .001), cancer detection rates per 1000 exams (CDRs) of 3.96 and 5.12 (451/113,973 and 317/61,896, respectively, p = .003), and positive predictive values for recall (PPV1s) of 4.64% and 7.54% (451/9726 and 317/4204, respectively, p < .001), respectively. In mammograms with implants, DM (n = 6815) and DM/DBT (n = 5138) yielded RRs of 5.81% and 4.87% (396/6815 and 250/5138, respectively, p = .158), CDRs of 2.49 and 2.92 (17/6815 and 15/5138, respectively, p > 0.999), and PPV1s of 4.29% and 6.0% (17/396 and 15/250, respectively, p > 0.999), respectively. CONCLUSIONS DM/DBT significantly improved recall rates, cancer detection rates, and positive predictive values for recall compared to DM alone in women without implants. DM/DBT performance in women with implants trended towards similar improvements, though no metric was statistically significant. KEY POINTS • Digital mammography with tomosynthesis improved recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women without implants. • Digital mammography with tomosynthesis trended towards improving recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women with implants, but these trends were not statistically significant - likely related to sample size.
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Affiliation(s)
- Ethan O Cohen
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Rachel E Perry
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Hilda H Tso
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Kanchan A Phalak
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Michele D Lesslie
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Karen E Gerlach
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jia Sun
- Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Ashmitha Srinivasan
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jessica W T Leung
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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O'Keefe JR, Wilkinson JM, Spuur KM. Current practice in mammographic imaging of the augmented breast in Australia. J Med Radiat Sci 2020; 67:102-110. [PMID: 31981297 PMCID: PMC7276184 DOI: 10.1002/jmrs.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
AIM This study seeks to document the imaging series used in contemporary Australian practice for imaging the augmented breast, with a secondary focus on differences in practice and opinion between BreastScreen Australia and diagnostic imaging services. METHODS A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and was assessable during December 2017 and January 2018. The questionnaire investigated: years of experience, facility type and location, image acquisition systems, appointment times, patients imaged per week, technique and imaging series used, use of limited compression views, rationale for variation in imaging series and the use of ultrasound. Descriptive statistics were produced for all variables with chi-squared tests used for comparisons between categorical variables. RESULTS The most frequently used series was the eight-image Eklund ID technique 64% and 59% (submuscular) and 68% and 58% (subglandular) for BSA and diagnostic services, respectively. Eighteen different combinations of projections were reported with eight combinations common to both subglandular and submuscular imaging. The majority of participants attributed imaging series preferences to dose reduction and radiologist preference. CONCLUSION This research has demonstrated varied approaches to the routine imaging of women with breast implants and identified the need for the establishment of dedicated evidence-based imaging protocols to ensure that regardless of which setting a woman attends that they receive standardised imaging with minimal dose and maximum breast coverage. This is a reassurance that is not applicable to current practice.
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Affiliation(s)
- Jacquelyn R O'Keefe
- Faculty of Science, School of Dentistry & Health SciencesCharles Sturt UniversityWagga WaggaNew South WalesAustralia
| | - Jenny Maree Wilkinson
- Faculty of Science, School of Dentistry & Health SciencesCharles Sturt UniversityWagga WaggaNew South WalesAustralia
| | - Kelly Maree Spuur
- Faculty of Science, School of Dentistry & Health SciencesCharles Sturt UniversityWagga WaggaNew South WalesAustralia
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Pyfer BJ, Jonczyk M, Jean J, Graham RA, Chen L, Chatterjee A. Analysis of Surgical Trends for Axillary Lymph Node Management in Patients with Ductal Carcinoma In Situ Using the NSQIP Database: Are We Following National Guidelines? Ann Surg Oncol 2020; 27:3448-3455. [PMID: 32232706 DOI: 10.1245/s10434-020-08374-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND For patients with ductal carcinoma in situ (DCIS), multiple national cancer organizations recommend that sentinel lymph node biopsy (SLNB) be offered when treated with mastectomy, but not when treated with breast-conserving surgery (BCS). This study analyzes national surgical trends of SLNB and axillary lymph node dissection (ALND) in DCIS patients undergoing breast surgery with the aim to quantify deviations from national guidelines. METHODS A retrospective cohort analysis of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2017 identified patients with DCIS. Patients were categorized by their primary method of breast surgery, i.e. mastectomy or BCS, then further categorized by their axillary lymph node (ALN) management, i.e. no intervention, SLNB, or ALND. Data analysis was conducted via linear regression and a non-parametric Mann-Kendall test to assess a temporal trend and Sen's slope. RESULTS Overall, 43,448 patients with DCIS met the inclusion criteria: 20,504 underwent mastectomy and 22,944 underwent BCS. Analysis of DCIS patients from 2005 to 2017 revealed that ALND decreased and SLNB increased in every subgroup, regardless of surgical treatment modality. Evaluation in the mastectomy group increased overall: mastectomy alone increased from 57.1 to 65.8% (p < 0.01) and mastectomy with immediate reconstruction increased from 58.5 to 72.1% (p < 0.01). Increases also occurred in the total BCS population: partial mastectomy increased from 14.0 to 21.1% and oncoplastic surgery increased from 10.5 to 23.0% (both p < 0.01). CONCLUSIONS Despite national guideline recommendations for the management of ALN surgery in DCIS patients, approximately 20-30% of cases continue to not follow these guidelines. This warrants further education for surgeons and patients.
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Affiliation(s)
| | | | - Jolie Jean
- Tufts University Medical School, Boston, MA, USA
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Robinson KA, Gray RJ, Tanna A, Kosiorek HE, Butterfield RJ, Palmieri JM, McDonough MAT, Rebecca AM, Patel BK. Patient-Awareness Survey: Do Breast Implants Affect the Acquisition and Accuracy of Screening Mammography? JOURNAL OF BREAST IMAGING 2019; 1:297-302. [PMID: 38424806 DOI: 10.1093/jbi/wbz062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/25/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Breast implant augmentation is the most common cosmetic surgical procedure performed in the United States. The purpose of this study was to determine if patients with breast augmentation surgery are aware of the effect of breast implants on the mammographic detection of cancer. METHODS An institutional review board exempt patient awareness survey was distributed at a single breast imaging facility to women undergoing screening mammography. Comparative statistical analyses were performed between patients with and without breast implants. RESULTS The respondents were divided into three groups: no prior breast surgery (74%; 524/711), breast surgery with implants (21%; 152/711), and breast surgery without implants (5%; 35/711). Patients with breast implants were more aware that implants decrease the amount of breast tissue seen on a mammogram (75%; 105/141) and that implants result in the need for more mammogram views (70%; 103/147), as compared with patients with no surgery (46%; 221/484 and 31%; 147/478, respectively) (P < 0.001). More women with breast implants reported learning from breast imaging staff rather than from their surgeon that implants decrease the amount of breast tissue seen on a mammogram (46%; 49/106 vs. 38%; 40/106). Of 137 respondents, 35% (n = 48) reported that the effect of implants on their mammogram was discussed preoperatively. Of those who did not recall a preoperative discussion, 42% (16/38) indicated this knowledge would have factored into their decision to get breast implants. CONCLUSION This study highlights an opportunity for providers to engage in more education and shared decision-making with patients considering breast augmentation surgery to ensure preoperative counseling includes discussion of the effect of implants on mammography.
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Affiliation(s)
| | - Richard J Gray
- Mayo Clinic Hospital, Department of Research Biostatistics, Phoenix, AZ
| | - Aneri Tanna
- Mayo Clinic Hospital, Department of Radiology, Phoenix, AZ
| | - Heidi E Kosiorek
- Mayo Clinic Hospital, Department of Research Biostatistics, Phoenix, AZ
| | | | | | | | - Alanna M Rebecca
- Mayo Clinic Hospital, Department of Plastic Surgery, Phoenix, AZ
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Azzi AJ, Gornitsky J, Viezel-Mathieu A, Lessard L. The Impact of Implant Location on Breast Cancer Characteristics in Previously Augmented Patients: A Systematic Literature Analysis. J Cancer Prev 2018; 23:93-98. [PMID: 30003070 PMCID: PMC6037212 DOI: 10.15430/jcp.2018.23.2.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/22/2018] [Accepted: 06/24/2018] [Indexed: 11/03/2022] Open
Abstract
Background There is a paucity of data comparing the oncologic properties of breast cancer among patients previously having undergone breast augmentation in either the subglandular or subpectoral planes. The objective of the present systematic review was to evaluate whether implant location influenced the characteristics of breast tumors in previously augmented women. Methods A systematic literature search was performed to identify relevant articles reporting tumor characteristics in augmented patients. The search included published articles in three electronic databases; Ovid MEDLINE, EMBASE, and PubMed. Comparative studies (subglandular vs. subpectoral) were included. Results Analysis of data pooled from the included studies showed that subglandular implants had a higher frequency of tumors between 2 to 5 cm (26.5% vs. 9.9%, P = 0.0130). Subglandular implants also had a higher frequency of stage 2 tumors (42.9% vs. 23.7%, P = 0.0308). There was no significant difference in lymphovascular invasion between the 2 groups. These results of this systematic review suggest that the prognosis of patients undergoing augmentation is unaffected by implant location (subpectoral vs. subglandular). Conclusions With the absence of large randomized controlled trials, our study provides surgeons with an evidence-based reference to improve informed consent with regards to implant placement.
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Affiliation(s)
- Alain Joe Azzi
- Division of Plastic and Reconstructive Surgery, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Jordan Gornitsky
- Department of Medicine, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Alex Viezel-Mathieu
- Division of Plastic and Reconstructive Surgery, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Lucie Lessard
- Division of Plastic and Reconstructive Surgery, McGill University Faculty of Medicine, Montreal, QC, Canada
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Abstract
BACKGROUND The purpose of this study was to determine whether augmentation mammaplasty, implant type, and implant location affect breast cancer detection, stage, and treatment. METHODS An institutional case-control study was performed of patients with prior breast augmentation undergoing breast cancer treatment from 2000 to 2013. Controls were propensity matched and randomized, and data were retrospectively reviewed. RESULTS Forty-eight cases and 302 controls were analyzed. Palpable lesions were detected at a smaller size in augmentation patients (1.6 cm versus 2.3 cm; p < 0.001). Fewer lesions in augmented patients were detected by screening mammography (77.8 percent of cases versus 90.7 percent of controls; p = 0.010). Patients with implants were more likely to undergo an excisional biopsy for diagnosis (20.5 percent versus 4.4 percent; p < 0.001), rather than image-guided core needle biopsy (77.3 percent versus 95.3 percent; p < 0.001). Earlier staging in augmented patients approached but did not reach statistical significance (p = 0.073). Augmented patients had higher mastectomy rates (74.5 percent versus 57.0 percent) and lower rates of breast-conservation therapy (25.5 percent versus 43 percent; p = 0.023). Neither implant fill type nor anatomic location affected method of diagnosis, stage, or treatment. CONCLUSIONS Palpable detection of breast cancer is more likely at a smaller size in augmented patients, yet it is less likely on screening mammography than in controls. Augmentation breast cancer patients have a comparable disease stage and are more likely to undergo mastectomy rather than lumpectomy. Both silicone and saline implants, whether placed submuscularly or subglandularly, have comparable effects on breast imaging, biopsy modality, and surgical intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy. Plast Reconstr Surg 2017; 139:1240e-1249e. [PMID: 28538550 DOI: 10.1097/prs.0000000000003342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast augmentation with subglandular versus subpectoral implants may differentially impact the early detection of breast cancer and treatment recommendations. The authors assessed the impact of prior augmentation on the diagnosis and management of breast cancer in women undergoing mastectomy. METHODS Breast cancer diagnosis and management were retrospectively analyzed in all women with prior augmentation undergoing therapeutic mastectomy at the authors' institution from 1993 to 2014. Comparison was made to all women with no prior augmentation undergoing mastectomy in 2010. Subanalyses were performed according to prior implant placement. RESULTS A total of 260 women with (n = 89) and without (n = 171) prior augmentation underwent mastectomy for 95 and 179 breast cancers, respectively. Prior implant placement was subglandular (n = 27) or subpectoral (n = 63) (For five breasts, the placement was unknown). Breast cancer stage at diagnosis (p = 0.19) and detection method (p = 0.48) did not differ for women with and without prior augmentation. Compared to subpectoral augmentation, subglandular augmentation was associated with the diagnosis of invasive breast cancer rather than ductal carcinoma in situ (p = 0.01) and detection by self-palpation rather than screening mammography (p = 0.03). Immediate two-stage implant reconstruction was the preferred reconstructive method in women with augmentation (p < 0.01). CONCLUSIONS Breast cancer stage at diagnosis was similar for women with and without prior augmentation. Among women with augmentation, however, subglandular implants were associated with more advanced breast tumors commonly detected on palpation rather than mammography. Increased vigilance in breast cancer screening is recommended among women with subglandular augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Current Trends in the Oncologic and Surgical Managements of Breast Cancer in Women with Implants: Incidence, Diagnosis, and Treatment. Aesthetic Plast Surg 2016; 40:256-65. [PMID: 26857708 DOI: 10.1007/s00266-016-0612-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Breast augmentation is the most common cosmetic surgery in the United States, and thousands of augmented patients develop breast cancer each year. The possible effects of implants on cancer incidence, diagnosis, and treatment usually generate a disarming confusion. The present paper represents an update of the more recent oncologic and surgical strategies, aiming to support plastic and general surgeons in such challenging aspects. Several aspects of breast cancer management in augmented women are investigated, including (1) risk estimation and cancer characteristics, stage at diagnosis, and prognosis; (2) cancer diagnosis with clinical examination, mammography, ultrasound, and magnetic resonance imaging; (3) cancer treatment including breast conservation, intraoperative radiotherapy, sentinel node biopsy and mastectomy, and reconstruction. A brief resume of recommendations and conclusions is suggested, elucidating correct trends in the oncologic management of augmented patients and refusing well-established misconceptions: (1) breast augmentation does not increase the risk of breast cancer incidence, and it does not influence the prognosis; (2) possible risks exist in cancer detection due to technical difficulties; (3) sentinel lymph node detection is feasible; (4) intraoperative radiotherapy represents a good chance for conserving treatment; (5) immediate reconstruction with submuscular-subfascial implants is the most common procedure after mastectomy, and biological substitutes could support this procedure. Breast clinicians should be alerted because of high expectations of this subgroup of patients, accustomed to emphasize the aesthetic result. LEVEL OF EVIDENCE V This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Abstract
OBJECTIVE The objective of our study was to characterize the MRI features of breast carcinomas detected in augmented breasts. MATERIALS AND METHODS A review of the MRI database identified 54 patients with biopsy-proven breast carcinoma in augmented breasts. The images were reviewed for the type and location of the implant and for the characteristics of the carcinoma. The cases included 46 (85%) invasive cancers (invasive ductal carcinoma, n = 35; invasive lobular carcinoma, n = 7; and mixed features, n = 4) and eight (15%) ductal carcinomas in situ. RESULTS The median age of the patients at diagnosis was 49 years (range, 28-72 years). Thirty-eight of the 54 cancers (70%) were palpable. The mean tumor size was 2.8 cm (range, 0.6-9.6 cm). Of the 54 cancers, 34 (63%) presented as masses and 20 (37%) as nonmass enhancement on MRI. There was no detectable difference between implant position and lesion morphology (p = 0.55) or tumor size (p = 1.00). Twenty of 54 (37%) carcinomas abutted the implant, 13 (24%) abutted the pectoralis major muscle, and two (4%) invaded the pectoralis major muscle. Of the tumors abutting the implant, 18 of 20 (90%) spread along the implant capsule for more than 0.5 cm. This pattern of tumor spread was more common in breasts with retroglandular implants (9/16, 56%) than in those with retropectoral implants (9/38, 24%) (p = 0.03). MRI detected the index carcinoma in 16 of 54 (30%) cases, showed a greater extent of disease than was visible on mammography or ultrasound in 21 of 52 (40%) cases, and detected an unsuspected contralateral carcinoma in three of 54 (6%) cases. CONCLUSION In augmented breasts, breast cancer often contacts either the implant or the pectoralis major muscle. Tumor spread along the implant contour is more often seen with retroglandular implants than with retropectoral implants. MRI should be considered to assess disease extent in women with augmented breasts before surgery.
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Hitier M, Ho Quoc C, La Marca S, Hamou C, Delay E. Tolérance et efficacité du lipomodelage comme élément de symétrisation en reconstruction mammaire : à propos de 150 patientes. ANN CHIR PLAST ESTH 2014; 59:311-9. [DOI: 10.1016/j.anplas.2014.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
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Carloni R, Delay E, Gourari A, Ho Quoc C, Tourasse C, Balleyguier C, Forme N, Goga D. Preoperative imaging prior to breast reconstruction surgery: benchmarking bringing together radiologists and plastic surgeons. Proposed guidelines. ANN CHIR PLAST ESTH 2014; 59:e13-9. [PMID: 24556529 DOI: 10.1016/j.anplas.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prescription of preoperatory imaging assessment prior to planned breast reconstruction surgery (reduction or augmentation mastoplasty, correction of congenital breast asymmetry) is poorly codified. The objective of this study was to analyze the attitudes of French radiologists and plastic surgeons with regard to prescription of preoperative imaging in the framework of non-oncologic breast surgery. MATERIAL AND METHODS This is a descriptive and comparative observational study involving two groups, one consisting of 50 plastic surgeons (P) and the other of 50 radiologists (R) specialized in breast imaging. A questionnaire was handed out to radiologists during a conference on breast imaging at the Institut Gustave-Roussy in Paris (France) held on 17th December 2012. The same questionnaire was handed out to plastic surgeons at the National Congress of the French Society of Plastic and Reconstructive Surgery (SOFCPRE) held on 19th, 20th and 21st November 2012, also in Paris (France). The questionnaire focused on prescription of preoperative and postoperative imaging evaluation for non-oncologic breast surgery in patients with no risk factors for breast cancer or clinically identified indications. RESULTS Forty-six percent of the plastic surgeons considered an imaging exam to be recent when it had been carried out over the previous 6 months, while 40% of the radiologists set the figure at 1 year. Clinical breast density exerted no influence on 92% of the plastic surgeons and 98% of the radiologists. A majority of the plastic surgeons would prescribe a preoperative exam regardless of age (57% for breast reduction, 61% for breast implant placement and 61% for surgical correction of asymmetry) while the radiologists would prescribe exams mainly for patients over 40 years (50% for reduction, 44% for augmentation, 49% for asymmetry correction). The plastic surgeons would prescribe either ultrasound or mammograms (59% for reduction, 72% for augmentation, 66% for asymmetry correction) while radiologists would usually prescribe mammograms (64%, 57%, 64%). Most of the radiologists, along with the plastic surgeons, did not think that postoperative examination is justified (58% of P and 62% of R for reduction, 56% P and 68% of R for augmentation, 52% of P and 64% of R for asymmetry correction). CONCLUSION In 2012, there existed no French consensus on prescription of a preoperative imaging assessment in the framework of non-oncologic breast surgery in patients without risk factors for breast cancer. Active cooperation bringing together radiologists and plastic surgeons is likely to facilitate the harmonizing of their respective practices. In this paper, we propose guidelines that could help them to synchronize their efforts.
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Affiliation(s)
- R Carloni
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - E Delay
- Plastic and reconstructive surgery, centre régional Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - A Gourari
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France; Plastic and reconstructive surgery, centre régional Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - C Ho Quoc
- Plastic and reconstructive surgery, centre régional Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - C Tourasse
- Hôpital privé Jean-Mermoz, 55, avenue Jean-Mermoz, 69008 Lyon, France
| | - C Balleyguier
- Imaging unit, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - N Forme
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - D Goga
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
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Rizki H, Nkonde C, Ching RC, Kumiponjera D, Malata CM. Plastic surgical management of the contralateral breast in post-mastectomy breast reconstruction. Int J Surg 2013; 11:767-72. [PMID: 23845265 DOI: 10.1016/j.ijsu.2013.06.844] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/27/2013] [Accepted: 06/28/2013] [Indexed: 01/08/2023]
Abstract
Breast reconstruction following mastectomy can be reliably undertaken using many different techniques. Although excellent cosmetic results can be achieved without contralateral balancing surgery, many unilateral breast reconstructions require a balancing procedure on the contralateral breast in order to achieve symmetry; the ultimate goal in breast reconstruction. This article attempts to summarise the existing literature on the plastic surgical management of the contralateral breast. It also outlines the multifactorial and complex issues involved in the planning and undertaking of such surgery with illustrative examples. The implications for future oncological management and radiological surveillance following the procedure are also discussed in brief.
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Affiliation(s)
- H Rizki
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Lavigne E, Holowaty EJ, Pan SY, Xie L, Villeneuve PJ, Morrison H, Brisson J. Do Breast Implants Adversely Affect Prognosis among Those Subsequently Diagnosed with Breast Cancer? Findings from an Extended Follow-Up of a Canadian Cohort. Cancer Epidemiol Biomarkers Prev 2012; 21:1868-76. [DOI: 10.1158/1055-9965.epi-12-0484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Mátrai Z, Gulyás G, Tóth L, Sávolt A, Kunos C, Pesthy P, Bartal A, Szabó E, Kásler M. [Special considerations in breast cancer treatment of an augmented breast]. Orv Hetil 2011; 152:1679-91. [PMID: 21979221 DOI: 10.1556/oh.2011.29189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet Általános és Mellkassebészeti Osztály Budapest Ráth György u. 7-9. 1122.
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Radiotransparency of polyvinylpyrrolidone-hydrogel and hydrogel breast implants: a quantitative analysis with mastectomy specimens. Aesthetic Plast Surg 2011; 35:203-10. [PMID: 20953958 DOI: 10.1007/s00266-010-9588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 06/25/2010] [Indexed: 10/18/2022]
Abstract
Breast cancer is the most common cancer in women. Past evidence suggested that women with silicone implants who had cancer presented with more advanced disease and had the worst prognosis due to difficulty visualizing early lesions on mammography. Hence, new filling materials have been developed. In this study, 10 mastectomy specimens were used. Mammograms of specimens alone and specimens covering polyvinylpyrrolidone-hydrogel and hydrogel implants were performed. The variables studied were number of mammograms necessary to examine each specimen, kilovolts and milliamperes of each mammogram, number of isolated microcalcifications, microcalcification clusters and macroscopic calcifications, and rarefaction areas. No significant differences were found in number of mammograms (p = 0.439), isolated microcalcifications (p = 0.178), macrocalcifications (p = 1.0), and presence of rarefaction areas (p = 0.368). The difference in number of microcalcification clusters was significant (p = 0.0498). Significant differences (p < 0.001) also were observed in the kilovolts and milliamperes of the mammograms performed for specimens alone versus those with implants. Polyvinylpyrrolidone-hydrogel and hydrogel breast implants allow adequate visualization of mammary glands at the expense of greater radiation doses, although it must be considered that the experimental situation does not fully match the real clinical setting.
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20
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Tang SSK, Gui GPH. A Review of the Oncologic and Surgical Management of Breast Cancer in the Augmented Breast: Diagnostic, Surgical and Surveillance Challenges. Ann Surg Oncol 2011; 18:2173-81. [DOI: 10.1245/s10434-011-1578-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Indexed: 11/18/2022]
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Xie L, Brisson J, Holowaty EJ, Villeneuve PJ, Mao Y. The influence of cosmetic breast augmentation on the stage distribution and prognosis of women subsequently diagnosed with breast cancer. Int J Cancer 2010; 126:2182-90. [PMID: 19569048 DOI: 10.1002/ijc.24697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aimed to determine whether cosmetic breast implants impair the early detection of breast cancer, and adversely influence survival. This analysis derives from a cohort of 24,558 women who received bilateral cosmetic breast implants, and 15,893 women who underwent other plastic surgery procedures at the same practices in Ontario and Quebec, Canada, between 1974 and 1989. Incident cancers and vital status through 1997 were determined by record linkage to the Canadian Cancer Registry and Canadian Mortality Database. Analyses are based on a total of 182 and 202 incident cases of breast cancer identified among the implant and control groups, respectively. Contingency table analyses were performed to test for differences in the stage distribution of breast cancers between the 2 groups. Potential differences in survival were evaluated using the Kaplan-Meier estimates and Cox proportional hazards models. Women who received breast implants were more likely to have advanced stage breast carcinoma relative to the other plastic surgery patients (crude and adjusted ps </= 0.01). No statistically significant differences in distributions between the implant and control patients were found for age at diagnosis, tumor size, histological type, period of diagnosis or length of follow-up. The delayed diagnosis in augmented women did not appear to influence the overall prognosis. Breast cancer-specific survival was similar in both groups (hazard ratio = 1.06; 95% confidence interval = 0.65-1.74). In conclusion, this study suggests that breast implants delay the detection of breast cancer, but there was no statistically significant difference in survival between the breast implant and other plastic surgery groups.
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Affiliation(s)
- Lin Xie
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada.
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22
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23
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Breast Cancer Screening Prior to Cosmetic Breast Surgery: ASPS Members’ Adherence to American Cancer Society Guidelines. Plast Reconstr Surg 2009; 124:1375-1385. [PMID: 20009821 DOI: 10.1097/prs.0b013e3181b988c4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Cheng NX, Liu LG, Hui L, Chen YL, Xu SL. Breast cancer following augmentation mammaplasty with polyacrylamide hydrogel (PAAG) injection. Aesthetic Plast Surg 2009; 33:563-9. [PMID: 19156460 DOI: 10.1007/s00266-008-9298-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
Polyacrylamide hydrogel (PAAG) as an implanted material for augmentation mammaplasty has been used for years in China. Many kinds of complications associated with PAAG use have been reported in the clinical literature. This report presents two cases of breast cancer occurring after injection of PAAG in augmented breasts. The delayed diagnosis and more aggressive disease due to PAAG injection should be cause for concern. It is very important to detect breast cancer early when it is covered by the induration of the injected gel and inflammation reaction after PAAG injection. PAAG injection for augmentation mammaplasty may affect the outcome of breast cancer diagnosis and prognosis.
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25
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Kobe K, Chin T, Aoki R, Hyakusoku H. A false-positive fluorodeoxyglucose positron emission tomography (FDG-PET) imaging result for a patient after augmentation mammaplasty. Aesthetic Plast Surg 2009; 33:611-5. [PMID: 19421809 DOI: 10.1007/s00266-009-9347-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 03/21/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various materials and methods have been used for augmentation mammaplasty since it was first performed in Japan in the late 1940s. Although augmentation mammaplasty is not associated with an increased risk of breast cancer, a number of studies have reported that breast implants, or subsequent changes around these foreign substances, can affect images made by mammography, CT, or MRI during breast cancer screening. A method that is increasingly being used to detect cancer is positron emission tomography (PET). METHODS To determine the effect of augmentation mammaplasty on PET imaging, we subjected ten women who had previously undergone augmentation mammaplasty to PET imaging as well as other imaging methods. We also measured tumor markers and performed pathologic studies. RESULTS The histologic analyses failed to detect any cases of malignancy. We assess the efficacy of PET for detecting breast cancer in women who had undergone augmentation mammaplasty and describe the features of the PET images of these women. Finally, we discuss future research objectives in relation to PET-based screening for breast cancer. CONCLUSION It is important to identify an imaging methodology that improves the detection of breast cancer in patients with a previous mammaplasty. We show here that FDG-PET may improve breast cancer detection after mammaplasty.
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Affiliation(s)
- Kyoko Kobe
- Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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26
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Lapierre-Combes M, Rousset J, Combes E, Chinelatto S, Dupré PF, André V. [Retrospective study conducted in northern Finistère about the role of breast MRI in normal breast screening, experience in 51 patients]. ACTA ACUST UNITED AC 2009; 37:401-9. [PMID: 19403322 DOI: 10.1016/j.gyobfe.2009.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 02/24/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To study the role and indications of breast MRI in normal breast screening. PATIENTS AND METHODS Retrospective study of 51 patients (mean age of 51 years) conducted in northern Finistère. Each patient had a normal (BI-RADS 1 or 2) breast screening (mammography and echography). Four indications for MRI were chosen: screening of high-risk patients, high-density breasts, radio-clinical discordance, and breasts prostheses. Breast MRI were reviewed according to BI-RADS classification. Abnormalities categorized in BI-RADS 4 or 5 were confirmed histologically. RESULTS Thirteen patients underwent histological analysis. Nine invasive carcinomas were identified (six invasive lobular carcinomas (ILC), two mixed carcinomas, one invasive ductal carcinoma). For these patients, the reason for performing MRI was a radio-clinical discordance. DISCUSSION AND CONCLUSION The study demonstrates the breast MRI value for radio-clinical discordance and the key role of MRI in diagnostic challenge of ILC. In literature review, MRI has a role even if breast screening is normal: radio-clinical discordance, screening of patients with high-risk, breasts prostheses in certain cases. Breast density comes as an additional criteria to perform this exam.
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Affiliation(s)
- M Lapierre-Combes
- Service d'imagerie médicale, hôpital d'instruction des armées Clermont-Tonnerre, BP 41, 29240 Brest Armées, France.
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27
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Vincent N, Barletta L, Laguens M. Breast implants as a preventive factor. Aesthetic Plast Surg 2008; 32:739-42. [PMID: 18551342 DOI: 10.1007/s00266-008-9181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 11/17/2006] [Indexed: 10/22/2022]
Abstract
After a large number of patients with silicone breast implants worldwide had been evaluated [2, 9], it was concluded that such implants were not carcinogenic. This allowed for experimentation with rats to determine the benefits and potential risks associated with implants. By means of a high-precision monitor, temperature measurements were obtained from 100 silicone-implanted rats. These measurements then were divided into various groups to compare the reaction of their implanted and nonimplanted mammary glands at different hormone levels. The temperature measurements were analyzed and compared. Dysthermia was detected in the skin area immediately overlying the implant. The results also demonstrated that at high hormone levels, implants act as neutralizing agents. By contrast, glandular alterations with severe signs of anisocytosis and anisokoryosis were observed in nonimplanted glands.
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Tanaka Y, Morishima I, Kikuchi K. Invasive micropapillary carcinomas arising 42 years after augmentation mammoplasty: a case report and literature review. World J Surg Oncol 2008; 6:33. [PMID: 18341700 PMCID: PMC2292720 DOI: 10.1186/1477-7819-6-33] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 03/14/2008] [Indexed: 11/10/2022] Open
Abstract
Background There has been no definitive consensus regarding the causal relationships between foreign bodies in the breast and carcinogenesis. This report describes the first case of invasive micropapillary carcinomas after augmentation mammoplasty. Multiple tumors located in immediate contact with the siliconomas suggested a causal link between the siliconomas and carcinomas. Case presentation This report presents the case of a 64-year-old female who underwent liquid silicone injections for augmentation mammoplasty 42 years previously. Eight years before admission, siliconomas of the left breast were removed due to pain and discomfort. The patient visited the hospital for further treatment of newly diagnosed carcinoma of the left breast. Images showed multiple tumors located in various areas of the left breast. The pathological findings of the left breast showed each tumor to be solitary and not continuous with the others. The tumors were diagnosed to be invasive micropapillary carcinomas, and they all came into immediate contact with the residual siliconomas. The siliconomas were therefore suspected to have played a causative role in the development of the breast cancer. Conclusion This rare case of multiple invasive micropapillary carcinomas following augmentation mammoplasty provides evidence that siliconomas may lead to carcinomas. Although a causal relationship was not established unequivocally, we review evidence that suggest silicone gel may cause cell damage responsible for carcinoma development.
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Affiliation(s)
- Yuko Tanaka
- Department of Breast and Thyroid Surgery Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba-city, Ibaraki, 305-0005, Japan.
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30
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Screening and diagnosis of breast cancer in augmented women. Breast Cancer 2008; 15:159-64. [DOI: 10.1007/s12282-008-0036-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 12/21/2007] [Indexed: 10/21/2022]
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31
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Breast Implants and Breast Cancer: A Review of Incidence, Detection, Mortality, and Survival. Plast Reconstr Surg 2007; 120:70S-80S. [DOI: 10.1097/01.prs.0000286577.70026.5d] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McIntosh SA, Horgan K. Augmentation mammoplasty: effect on diagnosis of breast cancer. J Plast Reconstr Aesthet Surg 2007; 61:124-9. [PMID: 18039600 DOI: 10.1016/j.bjps.2007.06.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 03/20/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
Abstract
Breast augmentation for cosmetic purposes is an increasingly common procedure in the USA and UK. In the USA in 2003, a total of 254 140 breast augmentation procedures were carried out [American Society of Plastic Surgeons, http://www.plasticsurgery.org/news_room/Procedural-Statistics-Press-Kit-Index.cfm9-1-2005; 2006.(1)]. It has been previously estimated that between 1 and 1.5 million women in the USA have prosthetic breast implants [Cook RR, Delongchamp RR, Woodbury M, et al. The prevalence of women with breast implants in the United States, 1989. J Clin Epidemiol 1995;48:519-25.(2)]. The UK National Breast Implant Registry has recorded a rise in the numbers of women receiving breast implants, with over 13 000 procedures registered in 2001; an estimated 77% of these were for cosmetic purposes. No association has been found between the presence of breast implants in a breast and an increased risk of breast cancer, and this subject has been comprehensively reviewed elsewhere [Hoshaw SJ, Klein PJ, Clark BD, et al. Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg 2001;107:1393-407.(3)]. However, as the population of women with breast implants ages, an increasing number of them will develop breast cancer; a reflection of the fact that the incidence of the disease increases with increasing age. Debate continues on the effect of breast implants on the efficacy of mammography in diagnosing breast cancer, and the role of other imaging techniques for this purpose, as well as the limitations that the presence of implants place on percutaneous biopsy techniques. We review the literature on the radiological and tissue diagnosis of breast cancer in women with a history of previous augmentation mammaplasty.
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Affiliation(s)
- S A McIntosh
- Department of Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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33
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Kaminski A, Amr D, Kimbrell ML, Difronzo LA. Lymphatic Mapping in Patients with Breast Cancer and Previous Augmentation Mammoplasty. Am Surg 2007. [DOI: 10.1177/000313480707301011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is now an established method of axillary staging in patients with breast cancer. However, the augmented breast poses an interesting challenge to this procedure. We hypothesized that SLNB is feasible in patients with augmented breasts who subsequently develop breast cancer. A retrospective study was performed from 1995 to 2006. Ten patients with augmented breasts underwent breast conservation therapy with SLNB. Sentinel lymph nodes were identified in all 10 patients. Three patients had positive sentinel nodes. Two patients proceeded to axillary lymph node dissection (ALND), and one declined. The subsequent ALND were negative for metastatic cancer. Seven patients had negative sentinel nodes. One patient with a negative sentinel node underwent ALND with all nodes negative for metastasis. Two patients were lost to follow-up. Of the remaining eight patients, the mean duration of follow-up was 71 months. None of these patients had evidence of axillary recurrence or distant metastasis at time of last follow-up. SLNB is a feasible method of axillary node staging in patients who have undergone augmentation mammoplasty who subsequently develop breast cancer. Further studies are needed to better determine the accuracy of lymphatic mapping in this patient population.
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Affiliation(s)
- Anna Kaminski
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Dena Amr
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | | | - L. Andrew Difronzo
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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34
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McIntosh SA, Horgan K. Breast cancer following augmentation mammoplasty - a review of its impact on prognosis and management. J Plast Reconstr Aesthet Surg 2007; 60:1127-35. [PMID: 17613294 DOI: 10.1016/j.bjps.2007.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 09/28/2006] [Accepted: 03/20/2007] [Indexed: 11/29/2022]
Abstract
The incidence of breast cancer in women with implants is increasing and will continue to do so for the foreseeable future due to the marked increase in breast implant insertion in recent years. Undoubtedly many of these women will wish to know whether the presence of implants worsens the prognosis of their breast cancer. Furthermore, the clinical management of such patients may be difficult, as aesthetic results are likely to be a major concern for women who have already undergone cosmetic surgery to the breast. There is no consensus on surgical approach to this scenario. This article reviews the literature on the prognosis of breast cancer patients with a history of augmentation mammoplasty and examines the available data regarding their surgical treatment.
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Affiliation(s)
- S A McIntosh
- Department of Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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35
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McCarthy CM, Pusic AL, Disa JJ, Cordeiro PG, Cody HS, Mehrara B. Breast Cancer in the Previously Augmented Breast. Plast Reconstr Surg 2007; 119:49-58. [PMID: 17255656 DOI: 10.1097/01.prs.0000244748.38742.1f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast cancer in a previously augmented breast raises questions regarding cancer detection and staging, surgical and adjuvant treatment options, reconstructive outcomes, management of the contralateral breast, and continued breast cancer surveillance. This article explores the oncologic and reconstructive issues relevant to women desiring cosmetic breast implants and women with breast cancer who have undergone prior cosmetic breast augmentation.
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Affiliation(s)
- Colleen M McCarthy
- New York, N.Y. From the Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center
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36
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Okada F. Beyond foreign-body-induced carcinogenesis: Impact of reactive oxygen species derived from inflammatory cells in tumorigenic conversion and tumor progression. Int J Cancer 2007; 121:2364-72. [PMID: 17893867 DOI: 10.1002/ijc.23125] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Foreign-body-induced carcinogenesis is a traditional, maybe old, way of understanding cancer development. A number of novel approaches are available today to elucidate cancer development. However, there are things we learn from the old, and thus I bring out some examples of various clinical cases and experimental models of foreign-body-induced tumorigenesis. What is notable is that the foreign bodies themselves are unrelated to each other, whereas commonly underlying in them is to induce inflammatory reaction, especially stromal proliferation, where those exogenous materials are incorporated and undigested. Such foreign-body-induced carcinogenesis is also recognized in the step of tumor progression, the final step of carcinogenesis that tumor cells acquire malignant phenotypes including metastatic properties. And the phenomenon is universally observed in several cell lines of different origins. In this review I would like to show the evidence that tumor development and progression are accelerated inevitably by inflammation caused from foreign bodies, and that reactive oxygen species derived from inflammatory cells are one of the most important genotoxic mediators to accelerate the process.
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Affiliation(s)
- Futoshi Okada
- Department of Biomolecular Function, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
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37
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Handel N, Silverstein MJ. Breast Cancer Diagnosis and Prognosis in Augmented Women. Plast Reconstr Surg 2006; 118:587-93; discussion 594-6. [PMID: 16932162 DOI: 10.1097/01.prs.0000233038.47009.04] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent years have witnessed growing concerns about the possible adverse effects of implants on breast cancer diagnosis and treatment. Numerous reports describe how implants might interfere with mammography and impair the ability to detect cancer. Several publications document the diminished sensitivity of mammography in augmented patients with palpable tumors. However, epidemiologic studies comparing stage of disease at time of diagnosis in augmented and nonaugmented women are equivocal. The purpose of this study was to review the authors' experience with a large number of breast cancer patients to determine whether implants impair early diagnosis or adversely affect prognosis. METHODS The authors reviewed their prospective database, which contains detailed information on 3953 nonaugmented and 129 augmented breast cancer patients. Various parameters of the two groups were compared and differences were analyzed using appropriate statistical methodology. RESULTS The authors' data reveal that augmented patients present with a statistically greater frequency of palpable lesions, have a slightly greater risk of invasive tumors, and have an increased likelihood of axillary lymph node metastases. Despite this, there was no statistically significant difference in stage of disease between augmented and nonaugmented patients; mean tumor size, recurrence rates, and breast cancer-specific survival were virtually identical in both groups. CONCLUSIONS Based on these findings, the authors conclude that despite the diminished sensitivity of mammography in women with implants, augmented and nonaugmented patients are diagnosed at a similar stage and have a comparable prognosis. While implants may impair mammography, they appear to facilitate detection of palpable breast cancers on physical examination.
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Affiliation(s)
- Neal Handel
- Division of Plastic Surgery, The David Geffen School of Medicine, University of California at Los Angeles, and the Keck School of Medicine, University of Southern California, USA.
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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. [PMID: 16848844 DOI: 10.1111/j.1075-122x.2006.00273.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Augmentation mammaplasty is rapidly becoming one of the most frequently performed cosmetic surgeries. However, as the augmented patient population ages, major concerns associated with the screening, diagnosis and treatment of breast cancer are being realized. Although current evidence convincingly indicates that breast implants do not play a role in inducing localized or systemic disease, particularly breast cancer, recent studies have shown implants not only reduce the sensitivity of mammography, but interfere with mammographic detection, possibly leading to delayed breast cancer diagnosis. In addition, the risk for local recurrence, as well as unfavorable cosmetic results, breast fibrosis, and capsular contracture following radiation therapy as part of breast-conserving therapy in previously augmented patients are of great concern. Given the overall lack of treatment consensus, paucity of literature, and increasing number of augmented breast cancer patients, we provide a retrospective review of the diagnosis, treatment, and follow-up of 12 augmented patients from 1998 to 2004 who developed breast cancer. Eight of 12 augmented patients presented with a palpable mass on physical examination, which prompted further mammographic evaluation. Abnormalities in the remaining four individuals were detected on routine mammographic screening. Pathology staging results were available for all 12 patients. Breast-conserving therapy was used to treat six patients and adequate negative pathologic margins were obtained in all patients. The remaining six patients were treated with mastectomy due to multifocal disease, inadequate margins, or proximity to the implant capsule. Thus far, one patient has had local recurrence and one patient has had distant recurrence after initial surgery. No evidence of local or systemic recurrence, infection, contracture, poor cosmetic outcome, or other complications has been detected in the remaining 10 patients as of the most recent follow-up. Based on this small cohort of augmented women, the presence of implants led to an increased proportion of palpable tumors, in spite of routine screening mammography. Consistent with other studies, although our results suggest a tendency toward delayed diagnosis in augmented women relative to age-matched controls, this did not appear to influence the overall prognosis.
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Affiliation(s)
- Richard Tuli
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Abstract
BACKGROUND A large follow-up study of cosmetic breast implant patients previously suggested an overall decrease in mortality but increased risks of brain and respiratory cancers and of suicides. METHODS This cohort of 12,144 implant patients and 3614 patients with other types of plastic surgeries was followed for 5 additional years, enabling derivations of standardized mortality ratios (SMRs) based on population rates and relative risks (RRs) based on comparisons with the other patients. RESULTS A total of 443 implant and 221 other plastic surgery patients were identified as deceased (SMR = 0.65 [95% confidence interval (CI) = 0.6-0.7] and 0.56 [0.5-0.6], respectively). Despite evidence that implants can interfere with mammographic visualization, there was no evidence that implant patients had a higher risk of death from breast cancer as compared with either the general population or other plastic surgery patients. The previous excess risk of brain cancer deaths among implant patients was attenuated by follow-up (as the result of no additional deaths; SMR = 1.43, 0.8-2.5; RR = 2.07, 0.5-8.9). A previously observed excess risk of respiratory cancer deaths persisted in comparisons with other plastic surgery patients (RR = 1.63; 1.0-2.7), but there was no evidence of a trend of risk with follow-up time. Implant patients also showed an elevated risk of suicide (SMR = 1.63, 1.1-2.3; RR = 2.58, 0.9-7.8) and of deaths caused by motor vehicle accidents (RR = 1.73; 0.6-5.4). CONCLUSIONS Although several elevations in cause-specific mortality were attenuated by additional follow-up, the excess risk of suicide among the implant patients remains of concern.
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Affiliation(s)
- Louise A Brinton
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
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Meunier A, Tristant H, Sinna R, Delay E. [Mammary implants and breast cancer]. ANN CHIR PLAST ESTH 2005; 50:595-604. [PMID: 16169139 DOI: 10.1016/j.anplas.2005.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 07/22/2005] [Indexed: 11/29/2022]
Abstract
Many publications deal with the impact of cosmetic breast implants to increase the breast cancer occurence or to delay its diagnosis. We first try to express the clinical and radiological differences in the implanted breast. The diagnostical and therapeutical difficulties were developped to the different technics of imagery, biopsy and specific management of the treatment. On one hand, the litterature revue does not show any significant difference in tumoral stage and nodal status between augmented and nonaugmented women eventhough the mammography sensibility is not as optimal. On the other hand, the global mortality of the augmented population is higher but it appears that this phenomenon could be link to their way of life and is totally independant of breast cancer. Finally, if the diagnosis and the treatment are more complex, the women survival is not altered by breast augmented surgery.
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Affiliation(s)
- A Meunier
- Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France.
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Grumbach Y. La présence de prothèses mammaires peut-elle être une cause de retard au diagnostic de cancer du sein? IMAGERIE DE LA FEMME 2005. [DOI: 10.1016/s1776-9817(05)80649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jakub JW, Ebert MD, Cantor A, Gardner M, Reintgen DS, Dupont EL, Cox CE, Shons AR. Breast Cancer in Patients with Prior Augmentation: Presentation, Stage, and Lymphatic Mapping. Plast Reconstr Surg 2004; 114:1737-42. [PMID: 15577343 DOI: 10.1097/01.prs.0000142482.08917.24] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine whether breast cancer patients who had prior breast augmentation presented at a more advanced stage than nonaugmented breast cancer patients, and to determine the mode of presentation and effectiveness of lymphatic mapping and sentinel lymph node biopsy in this same group of patients. A total of 4186 breast cancer patients from 1987 to 2002 were reviewed. Patients who had augmentation before their diagnosis of breast cancer were compared with a control group of nonaugmented breast cancer patients. The Wilcoxon rank sum test was used to compare tumor size, node positivity, and stage. The patient's age at presentation was also compared by the two-sided pooled t test. Seventy-six patients who previously underwent augmentation were identified with 78 breast cancers. Seventy percent (48 of 69) were initially detected by palpation, whereas 30 percent (21 of 69) were initially identified mammographically. Fifty-three percent (n = 41) underwent mastectomy and 47 percent (n = 37) underwent a lumpectomy. This compares with a 63.6 percent (2615 of 4110) breast conservation rate in the nonaugmented population during the same time period. The two groups did not differ regarding (tumor) size (p = 0.77), nodal positivity (p = 0.32), or stage (p = 0.34). The mean time between implant placement and a diagnosis of breast cancer was 14 years. The average age of the patients who had previously undergone augmentation at breast cancer diagnosis was 49.5 years (SD, 9.0 years) versus 57.1 years (SD, 13.5 years) for the nonaugmented patients (p < 0.0001). Forty-nine of the patients underwent lymphatic mapping, with a 100 percent success rate in identifying the sentinel lymph node. There have been no clinically detected axillary recurrences in the patients who had a negative sentinel lymph node biopsy. Breast cancer patients who have undergone previous augmentation are more likely to present with a palpable mass. This initial mode of detection does not appear to translate into a larger tumor size or worse prognosis. Breast conservation and lymphatic mapping can be performed successfully in previously augmented patients.
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Affiliation(s)
- James W Jakub
- Lakeland Regional Cancer Center Lakeland, Fla 33805, USA.
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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; discussion 1084-6. [PMID: 12621177 DOI: 10.1097/01.prs.0000046667.56931.e1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated. The surgical treatment of these patients is controversial, with several questions remaining unanswered. Is breast conservation therapy feasible in this patient population and can these patients retain their implants? A retrospective review of all breast cancer patients with a history of previous augmentation mammaplasty who were treated at the Revlon/UCLA Breast Center between 1991 and 2001 was performed. During the study period, 58 patients were treated. Thirty patients (52 percent) were treated with a modified radical mastectomy with implant removal. Twenty-eight patients (48 percent) underwent breast conservation therapy, which consisted of lumpectomy, axillary lymph node dissection, and radiotherapy. Twenty-two of the patients who underwent breast conservation therapy initially retained their implants. Eleven of those 22 patients (50 percent) ultimately required completion mastectomies with implant removal because of implant complications (two patients), local recurrences (five patients), or the inability to obtain negative margins (four patients). Nine additional patients experienced complications resulting from their implants, including contracture, erosion, pain, and rupture. The data illustrate that breast conservation therapy with maintenance of the implant is not ideal for the majority of augmented patients. Breast conservation therapy with explantation and mastopexy might be appropriate for rare patients with large volumes of native breast tissue. Mastectomy with immediate reconstruction might be a more suitable choice for these patients.
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Affiliation(s)
- Yvonne L Karanas
- Division of Plastic and Reconstructive Surgery and Surgical Oncology, Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, CA, USA.
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Affiliation(s)
- Mindy Smith
- Department of Family Practice, Michigan State University, Lansing, Michigan 48912, USA.
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Hou MF, Ou-Yang F, Chuang CH, Wang JY, Lee LW, Huang YS, Huang CJ, Hsieh JS, Lai CS, Lin SD, Huang TJ. Comparison between sonography and mammography for breast cancer diagnosis in oriental women after augmentation mammaplasty. Ann Plast Surg 2002; 49:120-6. [PMID: 12187337 DOI: 10.1097/00000637-200208000-00002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Augmentation mammaplasty has become more popular in Taiwan. Therefore, clinical imaging is necessary to evaluate those patients who develop breast cancers. The purpose of this study was to evaluate the detection of breast diseases after augmentation mammaplasty by means of mammography and sonography. A retrospective follow-up study and analysis of diagnostic methods including mammography, sonography, physical examination, and aspiration cytology was conducted on 105 patients who underwent augmentation mammaplasty at Kaohsiung Medical University Hospital between 1989 and 2001. A total of 105 patients were identified in this study, and mean follow-up was 4 years. Two tumors from 8 cancer patients were visible on standard mammograms, and seven tumors were diagnosed as cancer by sonography. One of 15 benign breast tumors was interpreted as a suspected cancer, and 7 tumors were interpreted as normal findings on mammograms. Fourteen of 15 benign breast tumors were diagnosed correctly except for one suspicious case examined by sonography. Sonography showed the highest rate of diagnostic accuracy (91.3%) and mammograms had the lowest rate (73.9%). The accuracy rate of physical examination was 73.9%, and aspiration cytology was 90.0% accurate. This study affirms that sonography is a more useful diagnostic tool than mammography in Taiwanese women who have undergone augmentation mammaplasty.
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Affiliation(s)
- Ming-Feng Hou
- Department of Surgery, Kaohsiung Medical University, Taiwan
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