The purpose of this study was to determine whether augmentation mammaplasty, implant type, and implant location affect breast cancer detection, stage, and treatment.
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.
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.
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.
This and Related “Classic” Articles Appear on Prsjournal.com for Journal Club Discussions.
Washington, D.C.; Baltimore, Md.; and McLean, Falls Church, and Reston, Va.
From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; the Department of Epidemiology, The Johns Hopkins University School of Medicine; National Center for Plastic Surgery; and Specialty Physicians of Northern Virginia, Reston Hospital Center.
Received for publication May 23, 2017; accepted October 2, 2017.
Presented at The Aesthetic Meeting 2015: 48th Annual Meeting of the American Society for Aesthetic Plastic Surgery, in Montreal, Quebec, Canada, May 14 through 19, 2015.
Disclosure: Dr. Spear was a consultant for LifeCell and Allergan. Dr. Nahabedian is a consultant for LifeCell, Allergan, and Chief Surgical Officer for PolarityTE. The rest of the authors do not have any conflict of interest or disclosures, and do not have any financial interest in any of the products or devices mentioned in this article. No funding was provided for the research or preparation of this article.
Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).
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.
Elizabeth D. Feldman, M.D., Specialty Physicians of Northern Virginia, Reston Hospital Center, 1860 Town Center Drive, Suite 440, Reston, Va. 20190, email@example.com