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Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy

Cho, Eugenia H. B.S.; Shammas, Ronnie L. B.S.; Phillips, Brett T. M.D., M.B.A.; Greenup, Rachel A. M.D., M.P.H.; Hwang, E. Shelley M.D., M.P.H.; Hollenbeck, Scott T. M.D.

Plastic & Reconstructive Surgery: June 2017 - Volume 139 - Issue 6 - p 1240e–1249e
doi: 10.1097/PRS.0000000000003342
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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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Durham, N.C.; and Philadelphia, Pa.

From the Divisions of Plastic and Reconstructive Surgery and Advanced Oncologic and Gastrointestinal Surgery, Duke University Health System; and the Department of Bioengineering, University of Pennsylvania.

Received for publication October 19, 2016; accepted December 7, 2016.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Scott T. Hollenbeck, M.D., Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Box 3945, Durham, N.C. 27710, scott.hollenbeck@duke.edu

©2017American Society of Plastic Surgeons