Background: Because of the prevalence of breast cancer, many augmented women eventually will develop the disease. This article reviews what is known about the effect of implants on the detection, prognosis, and treatment of carcinoma of the breast.
Methods: Observations were made on 4082 breast cancer patients (3953 nonaugmented and 129 augmented) treated over a 23-year time span. Findings in the two groups were compared and differences analyzed statistically. Mammograms of all women with palpable lesions were reviewed to assess mammographic sensitivity in patients with and without implants. Cosmetic outcomes in augmented patients treated with breast conservation therapy were reviewed.
Results: Augmented patients presented more frequently with palpable lesions, invasive tumors, axillary nodal metastases, and false-negative mammograms. However, there was no significant difference in stage of disease, tumor size, recurrence rates, or survival between the two groups. Augmented patients treated with breast conservation therapy often experienced poor cosmetic results and frequently required reoperation.
Conclusions: Despite the diminished sensitivity of mammography in women with implants, augmented and nonaugmented patients are diagnosed at a similar stage of disease and have a comparable prognosis. Implants may impair mammography but appear to facilitate tumor detection on physical examination. Magnetic resonance imaging and breast ultrasound may be useful adjuncts, but conventional mammography remains the most reliable tool for diagnosing early breast cancer in augmented patients. Breast implants do not interfere with mastectomy or breast reconstruction but may compromise the outcome of breast conservation therapy.
Santa Barbara, Calif.
From the Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles.
Disclosures: The author has no commercial associations that might create a conflict of interest with regard to the information presented in this article. The author has no patent licensing arrangements, stock ownership, or other equity interests in companies that manufacture products mentioned in the article. The author is a consultant to Mentor Corporation (Santa Barbara, Calif.) but has not received stipends or any other form of payment for conducting or publicizing the research described in this article.
Received for publication February 19, 2007; accepted June 28, 2007.
Neal Handel, M.D., 221 West Pueblo Street, Suite A, Santa Barbara, Calif. 93105, firstname.lastname@example.org