72 Breast Cancer After Breast Augmentation: A Multicenter Collaborative Study Of Patient Management and Outcomes

72 Breast Cancer After Breast Augmentation: A Multicenter Collaborative Study Of Patient Management and Outcomes

Background/Significance

Breast augmentation is the most commonly performed cosmetic surgical procedure worldwide. Challenges to the management of breast cancer in this subgroup include management of native breast tissue, the implant, contralateral breast, the capsule, and the role of radiotherapy. Studies looking at breast conserving surgery, mastectomy, and reconstruction in this subgroup are limited. We aimed to assess current UK practice in managing breast cancer in this subgroup and to evaluate the safety and outcomes compared with national standards.

Materials and Methods

A national multicenter collaborative model was employed involving 24 UK units. Women diagnosed with invasive cancer or ductal carcinoma in situ from January 2012 to January 2024 with preexisting implant augmentation were included. Clinicopathological data collected included type of surgery, management of the implant and capsule, contralateral surgery, complications, and adjuvant treatments.

Results

Data was collected on 212 women (median age, 51 years; IQR, 44-58). A total of 177 (83.5%) patients presented symptomatically, while 30 (14.2%) were detected through breast screening. Of the patients, 143 (67.5%) underwent breast-conserving surgery, with 28 (19.6%) requiring further margin reexcision and 4 (2.8%) needing completion mastectomy. In the breast-conserving surgery group, 108 (75.5%) patients retained or exchanged their implants and 111 (77.6%) did not have manipulation of the implant capsule. Implant or capsule exchange/surgery was lower in patients with implants in the subpectoral plane. Ninety-three percent of breast-conserving surgery patients received adjuvant radiotherapy. Some 73 (34.4%) patients underwent mastectomy, of which 39 (53%) had reconstruction, predominantly implant-based (94%). Implant-related complications (infection, reoperation, implant loss) in the mastectomy groups were comparable or lower than in published national reconstruction audits.

Conclusion

This is the largest reported series of patients with breast cancer and prior cosmetic augmentation worldwide. Surgical management is diverse, with breast-conserving surgery and re-excision rates comparable to national standards but may be higher in patients with T2 tumors. In mastectomy patients, prior augmentation may be protective against complications such as implant loss. Prospective studies with long-term outcomes, including patient-reported outcome measures, are required to determine the optimal management for this subgroup of patients with breast cancer who still pose specific challenges.