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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2011

01-08-2011 | Breast Oncology

A Review of the Oncologic and Surgical Management of Breast Cancer in the Augmented Breast: Diagnostic, Surgical and Surveillance Challenges

Authors: Sarah S. K. Tang, MBBS, Gerald P. H. Gui, MBBS

Published in: Annals of Surgical Oncology | Issue 8/2011

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Abstract

Background

The challenges of managing breast cancer in women with augmented breasts include screening, diagnosis, oncologic and revisional surgery, and surveillance. In addition, women with augmented breasts frequently have greater expectations of cosmetic outcomes. More breast clinicians will be affected by these challenges as augmentation grows in popularity and women with implants reach the age range in which they are at higher risk of developing breast cancer. In the United States, more than 2 million women have undergone augmentation, making this the second most commonly performed cosmetic procedure.1 With a lifetime risk of developing breast cancer of 1 in 8, it is projected that more than 50,000 women who undergo augmentation each year in the United States will develop breast cancer at some point in their lives.2

Methods

This is a review of current practice based on an exhaustive literature search of PubMed, Google Scholar, and conference proceedings. A series of case studies is presented to illustrate mammographic changes and cosmetic outcomes in augmented breasts that have required treatment for breast cancer.

Results

An evidence-based summary of recommendations has been produced to guide breast surgeons in managing this particular group of patients.

Conclusions

Management of breast cancer in previously augmented breasts presents a unique range of challenges. Patients can be reassured that the presence of an implant does not increase the risk of breast cancer developing or affect the prognosis if breast cancer does develop. Clinical judgement is made balancing surgical and oncologic principles to provide the best cosmetic outcome.
Literature
1.
American Society for Aesthetic Plastic Surgery. Statistics on cosmetic surgery. New York: Cosmetic Surgery National Data Bank, American Society of Aesthetic Plastic Surgery Communications Office; 2007.
2.
3.
Berkel H, Birdsell DC, Jenkins H. Breast augmentation: a risk factor for breast cancer? N Engl J Med. 1992;326:1649–53.PubMedCrossRef
4.
Deapen DM, Brody GS. Augmentation mammaplasty and breast cancer: a 5-year update of the Los Angeles Study. Plast Reconstr Surg. 1992;89:660–5.PubMedCrossRef
5.
Deapen DM, Bernstein L, Brody GS. Are breast implants anticarcinogenic? A 14-year follow-up of the Los Angeles study. Plast Reconstr Surg. 1997;99:1346–53.PubMedCrossRef
6.
Deapen D. Breast implants and breast cancer: a review of incidence, detection, mortality and survival. Plast Reconstr Surg. 2007;120:705–805.CrossRef
7.
Brisson J, Holowaty EJ, Villeneuve PJ, Xie L, Ugnat A-M, Latulippe L, Mao Y. Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation. Int J Can. 2006;118:2854–62.CrossRef
8.
Lamm SH. Silicone breast implants and long-term health effects: when are data adequate? J Clin Epidemiol. 1995;48:507–11.PubMedCrossRef
9.
Hoshaw SJ, Klein PJ, Clark BD, Cook RR, Perkins LL. Breast implants and cancer: causation, delayed detection and survival. Plast Reconstr Surg. 2001;107:1393–407.PubMedCrossRef
10.
Brinton LA, Lubin JH, Burich MC, Colton T, Brown SL, Hoover RN. Breast cancer following augmentation mammoplasty (United States). Cancer Causes Control. 2000;11:819–27.PubMedCrossRef
11.
Friis S, McLaughlin JK, Mellemkjaer L, Kjøller KH, Blot WJ, Boice JD Jr, Fraumeni JF Jr, Olsen JH. Breast implants and cancer risk in Denmark. Int J Cancer. 1997;71:956–8.PubMedCrossRef
12.
Mellemkjaer L, Kjoller K, Friis S, et al. Cancer occurrence after cosmetic breast implantation in Denmark. Int J Cancer. 2000;88:301–6.PubMedCrossRef
13.
Friis S, Hölmich LR, McLaughlin JK, Kjøller K, Fryzek JP, Henriksen TF, Olsen JH. Cancer risk among Danish women with cosmetic breast implants. Int J Cancer. 2006;118:998–1003.PubMedCrossRef
14.
McLaughlin JK, Fraumeni JF Jr, Nyren O, Adami HO. Silicone breast implants and risk of cancer? JAMA. 1995;273:116.PubMedCrossRef
15.
McLaughlin JK, Nyrén O, Blot WJ, Yin L, Josefsson S, Fraumeni JF Jr, Adami HO. Cancer risk among women with cosmetic breast implants: a population based cohort study in Sweden. J Natl Cancer Inst. 1998;90:156–8.CrossRef
16.
McLaughlin JK, Lipworth L, Fryzek JP, Ye W, Tarone RE, Nyren O. Long-term cancer risks among Swedish women with cosmetic breast implant: an update of a nationwide study. J Natl Cancer Inst. 2006;98:557–60.CrossRef
17.
Pukkala E, Boice JD, Hovi SL, et al. Incidence of breast and other cancers among Finnish women with cosmetic breast implants. J Long-Term Eff Med Implants. 2002;12:271–9.
18.
Cook LS, Daling JR, Voigt LF, de Hart MP, Malone KE, Stanford JL, Weiss NS, Brinton LA, Gammon MD, Brogan D. Characteristics of women with and without breast augmentation. JAMA. 1997;277:1612–7.PubMedCrossRef
19.
Fryzek JP, Weiderpass E, Signorello LB, Hakelius L, Lipworth L, Blot WJ, McLaughlin JK, Nyren O. Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery patients and women in the general population of Sweden. Ann Plast Surg. 2000;45:349–56.PubMedCrossRef
20.
Kjoller K, Holmich LR, Fryzek JP, Jacobsen S, Bittmann S, Olsen JH. Characteristics of women with cosmetic breast implants compared with women with other types of cosmetic surgery and population-based controls in Denmark. Ann Plast Surg. 2003;50:6–12.PubMedCrossRef
21.
Dreyfuss DA, Singh S, Dowlatshahi K, Krizek TJ. Silicone implants as an anticarcinogen. Surg Forum. 1987;38:587–8.
22.
Ramasastry SS, Weinstein LW, Zerbe A, Narayanan K, LaPietra D, Futrell JW. Regression of local and distant tumor growth by tissue expansion: An experimental study of mammary carcinoma 13,762 in rats. Plast Reconstr Surg. 1991;87:1–7.PubMedCrossRef
23.
Su CW, Dreyfuss DA, Krizek TJ, Leoni KJ. Silicone implants and the inhibition of cancer. Plast Reconstr Surg. 1995;96:513–8.PubMedCrossRef
24.
Kusano AS, Trichopoulos D, Terry KL, Chen WY, Willett WC, Michels KB. A prospective study of breast size and premenopausal breast cancer incidence. Int J Cancer. 2006;118:2031–4.PubMedCrossRef
25.
Clark CP, Peters GN, O’Brien KM. Cancer in the augmented breast. Diagnosis and prognosis. Cancer. 1993;72:2170–4.PubMedCrossRef
26.
Carlson GW, Curley SA, Martin JE, Fornage BD, Ames FC. The detection of breast cancer after augmentation mammoplasty. Plast Reconstr Surg. 1993;91:837–40.PubMedCrossRef
27.
Raso DS, Greene WB, Kalasinsky VF, et al. Elemental analysis and clinical implications of calcification deposits associated with silicone breast implants. Ann Plast Surg. 1999;42:117–23.PubMed
28.
Miglioretti DL, Rutter CM, Geller BM, et al. Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA. 2004;291:442–50.PubMedCrossRef
29.
Monsees BS, Destouet JM. Mammography in aesthetic and reconstructive breast surgery. Perspect Plast Surg. 1991;5:103–19.
30.
Handel N, Silvestein MJ, Gamagami P, Jensen JA, Collins A. Factors affecting mammographic visualization of the breast after augmentation mammaplasty. JAMA. 1992;268:1913–7.PubMedCrossRef
31.
Handel N, Silverstein MJ, Gamagami P. The effect of silicone-gel-filled implants on mammography. Cancer. 1991;68:1159–63.PubMedCrossRef
32.
Eklund GW, Busby RC, Miller SH, Job JS. Improved imaging of the augmented breast. Am J Roentgenol. 1988;151:469–73.
33.
Silverstein MJ, Handel N, Gamagami P, Waisman E, Gierson ED. Mammographic measurements before and after augmentation mammaplasty. Plast Reconstr Surg. 1990;86:1126–30.PubMedCrossRef
34.
Skinner KA, Silberman H, Dougherty W, Gamagami P, Waisman J, Sposto R, Silverstein MJ. Breast cancer after augmentation mammoplasty. Ann Surg Oncol. 2001;8:138–44.PubMedCrossRef
35.
Ahn CY, DeBruhl ND, Gorczyca DP, Shaw WW, Bassett LW. Comparative silicone breast implant evaluation using mammography, sonography, and magnetic resonance imaging: experience with 59 implants. Plast Reconstr Surg. 1994;94:620–7.PubMedCrossRef
36.
Berg WA, Caskey CI, Hamper UM, et al. Single and double lumen silicone breast implant integrity: prospective evaluation of MR and US criteria. Radiology. 1995;197:45–52.PubMed
37.
Silverstein MJ, Lagios MD, Recht A, et al. Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg. 2005;201:586–97.PubMedCrossRef
38.
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.PubMedCrossRef
39.
Lehman CD. Role of MRI in screening women at high risk of breast cancer. J Magn Reson Imaging. 2006;24:964–70.PubMedCrossRef
40.
Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004;351:427–47.PubMedCrossRef
41.
Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 2005;365:1769–78.PubMedCrossRef
42.
Mitnick JS, Vazquez MF, Plesser K, Pressman P, Harris MN, Roses DF. Fine needle aspiration biopsy in patients with augmentation prostheses and a palpable mass. Ann Plast Surg. 1993;31:241–4.PubMedCrossRef
43.
Jackman RL, Lamm RL. Stereotactic histologic biopsy in breasts with implants. Radiology. 2002;222:157–64.PubMedCrossRef
44.
Handel N. The effect of silicone implants on the diagnosis, prognosis and treatment of breast cancer. Plast Reconstr Surg. 2007;120:81–93.CrossRef
45.
Holmich LR, Mellemkjaer L, Gunnarsdottir KA, et al. Stage of breast cancer at diagnosis among women with cosmetic breast implants. Br J Cancer. 2003;88:832–8.PubMedCrossRef
46.
Jakub JW, Ebert MD, Cantor A, et al. Breast cancer in patients with prior augmentation: presentation, stage and lymphatic mapping. Plast Reconstr Surg. 2004;114:1737–42.PubMedCrossRef
47.
Cahan AC, Ashikari R, Pressman P, Cody H, Hoffman S, Sherman JE. Breast cancer after breast augmentation with silicone implants. Ann Surg Oncol. 1995;2:121–5.PubMedCrossRef
48.
Deapen D, Hamilton A, Bernstein L, Brody GS. Breast cancer stage at diagnosis and survival among patients with prior breast implants. Plast Reconstr Surg. 2000;105:535–40.PubMedCrossRef
49.
Park AJ, Black RJ, Sarhadi NS, Chetty U, Watson AC. Silicone gel-filled implants and connective tissue diseases. Plast Reconstr Surg. 1998;101:261–8.PubMedCrossRef
50.
Petit JY, Lê M, Rietjens M, Contesso G, Lehmann A, Mouriesse H. Does long-term exposure to gel-filled silicone implants increase the risk of relapse after breast cancer? Tumori. 1998;84:525–8.PubMed
51.
Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with and without breast implants. Plast Reconstr Surg. 1993;92:795–800.PubMedCrossRef
52.
Villeneuve PJ, Holowaty EJ, Brisson J, Xie L, Ugnat A-M, Latulippe L, Mao Y. Mortality among Canadian women with cosmetic breast implants. Am J Epidemiol. 2006;164:334–41.PubMedCrossRef
53.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRef
54.
Veronesi U, Saccozzi R, Delvecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305:6–11.PubMedCrossRef
55.
Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312:665–73.PubMedCrossRef
56.
Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1989;320:822–8.PubMedCrossRef
57.
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–61.PubMedCrossRef
58.
Holli K, Saaristo R, Isola J, Joensuu H, Hakama M. Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study. Br J Cancer. 2001;84:164–9.PubMedCrossRef
59.
NIH Consensus Conference. Treatment of early stage breast cancer. JAMA. 1991;265:391–5.
60.
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.PubMedCrossRef
61.
Kuske RR, Schuster R, Klein E, Young L, Perez CA, Fineberg B. Radiotherapy and breast reconstruction: clinical results and dosimetry. Int J Radiat Oncol Biol Phys. 1991;21:339–46.PubMedCrossRef
62.
Krishnan L, Krishnan EC. Electron beam irradiation after reconstruction with silicone gel implant in breast cancer. Am J Clin Oncol. 1986;9:223–6.PubMedCrossRef
63.
Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: Recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930–42.PubMedCrossRef
64.
Vadeweyer E, Deraemaecker R. Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg. 1995; 106;56–8.
65.
Evans GR, Schusterman MA, Kroll SS, Miller MJ, Reece GP, Robb GL, Ainslie N. Reconstruction and the radiated breast: is there a role for implants? Plast Reconstr Surg. 1995;96:1111–5.PubMedCrossRef
66.
Carlson GW, Moore B, Thornton JF, Elliott M, Bolitho G. Breast cancer after augmentation mammaplasty: treatment by skin-sparing mastectomy and immediate reconstruction. Plast Reconstr Surg. 2001;107:687–92.PubMedCrossRef
67.
Handel N, Lewinsky B, Jensen JA, Silverstein MJ. Breast conservation therapy after augmentation mammaplasty: is it appropriate? Plast Reconstr Surg. 1996;98:1216–24.PubMedCrossRef
68.
Handel N, Lewinsky B, Silverstein MJ, Gordon P, Zierk K. Conservation therapy for breast cancer following augmentation mammaplasty. Plast Reconstr Surg. 1991;87:873–8.PubMedCrossRef
69.
Mark RJ, Zimmerman RP, Greif JM. Capsular contracture after lumpectomy and radiation therapy in patients who have undergone uncomplicated bilateral augmentation mammoplasty. Radiology. 1996;200:621–5.PubMed
70.
Spear SL, Slack C, Howard MA. Postmastectomy reconstruction of the previously augmented breast: diagnosis, staging, methodology, and outcome. Plast Reconstr Surg. 2001;107:1167–76.PubMedCrossRef
71.
Victor SJ, Brown DM, Horwitz EM, et al. Treatment outcome with radiation therapy after breast augmentation or reconstruction in patients with primary breast carcinoma. Cancer. 1998;82:1303–9.PubMedCrossRef
72.
Bosworth JL, Chossein NA. Limited surgery, radiotherapy in the treatment of localized breast cancer: an overview. Surg Clin N Am. 1984;64:1115–23.PubMed
73.
Gray RJ, Forstner-Barthell AW, Pockaj BA, Schild SE, Halyard MY. Breast-conserving therapy and sentinel lymph node biopsy are feasible in cancer patients with previous implant breast augmentation. Am J Surg. 2004;188:122–5.PubMedCrossRef
74.
Prado A, Andrades P, Leniz P. Implications of transaxillary breast augmentation: lifetime probability of breast cancer development and sentinel lymph node mapping interference. Aesthet Plast Surg. 2007;31:317–9.CrossRef
75.
Lyman GH, Guiliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.PubMedCrossRef
76.
Graf RM, Canan LW Jr, Romano GG, Tolazzi AR, Cruz GA. Re: Implications of transaxillary breast augmentation: lifetime probability of breast cancer development and sentinel lymph node mapping interference. Aesthet Plast Surg. 2007;31:322–4.CrossRef
77.
Mottura AA, Del Castillo R. Transaxillary breast augmentation: two breast cancer patients with successful sentinel lymph node diagnosis. Aesthet Plast Surg. 2007;31:544–9.CrossRef
78.
Munhoz AM, Aldrighi C, Ono C, et al. The influence of subfacial transaxillary breast augmentation in axillary lymphatic drainage patterns and sentinel lymph node detection. Ann Plast Surg. 2007;58:141–9.PubMedCrossRef
79.
Munhoz AM, Aldrighi C, Buschpiegel C, et al. The feasibility of sentinel lymph node detection in patients with previous transaxillary implant breast augmentation: preliminary results. Aesth Plast Surg. 2005;29:163–8.CrossRef
80.
Shons AR. Breast cancer and augmentation mammoplasty: the preoperative consultation. Plast Reconstr Surg. 2002;109:383–5.PubMedCrossRef
Metadata
Title
A Review of the Oncologic and Surgical Management of Breast Cancer in the Augmented Breast: Diagnostic, Surgical and Surveillance Challenges
Authors
Sarah S. K. Tang, MBBS
Gerald P. H. Gui, MBBS
Publication date
01-08-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 8/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1578-6

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