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Kim N, Cho WK, Park W, Lee JE, Nam SJ, Kim SW, Yu J, Chae BJ, Lee SK, Ryu JM, Ko ES, Kim H. Outcomes of whole breast radiation therapy in Asian breast cancer patients with prior cosmetic implants. Breast Cancer 2024; 31:391-400. [PMID: 38368487 DOI: 10.1007/s12282-024-01547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND As breast augmentation has become more popular, an increasing number of women with augmented breasts require treatment for breast cancer. This study aimed to assess the outcomes of postoperative whole breast radiation therapy (WB-RT) in Asian patients with breast cancer who underwent prior cosmetic breast implantation. METHODS We retrospectively reviewed the medical records of 61 patients with breast cancer who had prior cosmetic breast implants (prior-CBI) and underwent breast-conserving surgery (BCS) and WB-RT between 2015 and 2020. The median implant volume was 238.8 cc, with a median interval of 84.7 months between the prior-CBI and BCS. WB-RT was administered with either conventional fractionation (CF-RT) at 50 Gy in 25 fractions (N = 36) or hypofractionation (HF-RT) at 42.6 Gy in 16 fractions (N = 25). The incidences of implant-related complications (IRC) and their contributing factors were analyzed. RESULTS After a median follow-up of 43.5 months, the 3-year cumulative incidences of IRC and implant loss were 17.2% and 4.9%, respectively. Among the four (6.6%) patients who opted for implant removal after RT, three were potentially related to RT-related capsular contracture. There was no difference in the 3-year cumulative IRC rates following CF-RT and HF-RT (12.2% and 26.7%, respectively; p = 0.120). The risk factors for IRC included a larger implant size (> 260 cc) and a higher ratio of breast tissue to implant volume. CONCLUSIONS This study demonstrated a favorable safety profile of WB-RT for treatment of breast cancer in Asian women with prior-CBI. The integration of HF-RT following BCS was thought to be a feasible approach.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sei Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai-Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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Grzywacz VP, Lehrberg AV, Quinn TJ, Zureick AH, Sarvepalli N, Oliver LN, Dekhne NS, Dilworth JT. Breast Conserving Therapy for Patients With Prior Cosmetic Implant-Based Breast Augmentation: Outcomes and Comparison Against a Matched Cohort. Clin Breast Cancer 2024; 24:227-236. [PMID: 38185608 DOI: 10.1016/j.clbc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Controversy exists regarding potential increased toxic effects in patients with cosmetic implant-based augmentation (CIBA) who receive radiation therapy. We evaluated acute and chronic toxic effects associated with radiation therapy in women with prior CIBA treated with whole-breast irradiation (WBI) as part of breast conserving therapy (BCT) and compared these results against a cohort of patients without prior breast augmentation who received similar therapy. METHODS A retrospective review was performed to identify patients with a prior history of CIBA who subsequently underwent BCT with WBI. The control group consisted of consecutively treated patients without prior CIBA who also underwent BCT with WBI. Analyses included a comparison of baseline and treatment-associated factors between the augmentation and control groups, evaluation of toxic effects between both groups, and multivariable analysis of factors associated with the receipt of additional surgery following radiation. RESULTS Thirty-six patients with prior CIBA and 135 consecutively treated patients without CIBA were identified. Patients with prior CIBA were treated from 2006 through 2019, and patients without CIBA were treated from 2016 through 2019, though treatment characteristics and median follow-up time were similar between the two groups. Patients with prior CIBA were significantly less likely to experience acute moist desquamation (0% vs. 18%; P = .005). There were otherwise no statistically significant differences in acute (≤ 6 months) or chronic (> 6 months) toxic effects between the two groups. Rates of excellent/good chronic cosmetic outcome were 89% for the CIBA group and 97% in the control group (P = .094). On multivariable analysis, patients without prior CIBA (OR = 0.04; CI = 0.01-0.13; P < .001) and patients treated with moderately hypofractionated irradiation (OR = 0.08; CI = 0.02-0.23; P < .001) were significantly less likely to undergo additional surgery following receipt of WBI. Two patients experienced implant loss following radiation therapy. CONCLUSIONS WBI as part of BCT in patients with prior implant-based breast augmentation appears safe and is associated with favorable cosmetic outcomes. There was an increased need for additional surgery in patients with prior CIBA, but rates of acute and chronic toxic effects appeared similar to those in nonaugmented patients.
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Affiliation(s)
- Vincent P Grzywacz
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI
| | - Anna V Lehrberg
- Department of Surgery, Henry Ford Cancer Center, Detroit, MI
| | - Thomas J Quinn
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI
| | - Andrew H Zureick
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI
| | - Neha Sarvepalli
- Comprehensive Breast Care Center, William Beaumont University Hospital, Royal Oak, MI
| | - Lauren N Oliver
- Department of Plastic and Reconstructive Surgery, William Beaumont University Hospital, Royal Oak, MI
| | - Nayana S Dekhne
- Comprehensive Breast Care Center, William Beaumont University Hospital, Royal Oak, MI
| | - Joshua T Dilworth
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI.
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Claudic Y, Perruisseau-Carrier A, Ta P, Seizeur R, Hu W. Anatomic Study of the Integrity of the Breast Lymphatic Network With Indocyanine Green in Breast Implant Surgery Through the Axillary Approach. Ann Plast Surg 2023; 90:S112-S119. [PMID: 36752502 DOI: 10.1097/sap.0000000000003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The performance of a prosthetic breast augmentation through the axilla always makes the surgeon fear the possibility of damage to the breast lymphatic network. Indocyanine green is a fluorescent marker allowing the analysis of the lymphatic system. This anatomical work aims at demonstrating, thanks to the use of indocyanine green, whether the realization of a prosthetic breast augmentation by axillary way leads to lesions of the breast lymphatic network and also seeks to show the feasibility of detecting the axillary sentinel node after axillary breast augmentation. MATERIAL AND METHOD This is an anatomical study. After injection of indocyanine green in the periareolar area, a prosthetic breast augmentation was performed through the axilla. At the end of the procedure, a change in the distribution of indocyanine green in the skin or its abnormal presence was sought: at the level of the skin incision, the prosthetic space, or in contact with the prosthesis itself. The presence of green in these situations was synonymous with a lesion of the lymphatic network. In the opposite case, we considered that the lymphatic system was respected. After sampling, an axillary lymph node we also looked for the presence of indocyanine green at its contact. RESULTS We performed 22 breast injections. The lymphatic network could be demonstrated in 15 of them. Among these 15 injections, 12 (80%) were in favor of a preservation of the lymphatic network, whereas 3 (20%) evoked a lesion of the lymphatic network. In all subjects (100%), an axillary lymph node was found with the presence of indocyanine green within it. CONCLUSION Our study is in favor of a preservation of the lymphatic network during a prosthetic breast augmentation by axillary way. Furthermore, with the collection of an axillary lymph node containing the dye from each subject, this work demonstrates the feasibility of axillary sentinel node detection with indocyanine green after axillary breast augmentation. Further work on live subjects and on a larger number of subjects would be necessary to confirm these results.
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Affiliation(s)
- Yannis Claudic
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Micro- and Hand Surgery, Brest University Hospital, University of Brest, Boulevard Tanguy Prigent, Brest, France
| | - Anne Perruisseau-Carrier
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Micro- and Hand Surgery, Brest University Hospital, University of Brest, Boulevard Tanguy Prigent, Brest, France
| | - Pierre Ta
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Micro- and Hand Surgery, Brest University Hospital, University of Brest, Boulevard Tanguy Prigent, Brest, France
| | - Romuald Seizeur
- Department of Anatomy, Medical School, University of Brest, Brest, France
| | - Weiguo Hu
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Micro- and Hand Surgery, Brest University Hospital, University of Brest, Boulevard Tanguy Prigent, Brest, France
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Salinas HM, Ainuz BY, Pourmoussa AJ, Levitt EB, Ali A, Bouz A, Treiser MD, Medina MA. Oncoplastic Augmentation Mastopexy in Breast Conservation Therapy: Retrospective Study and Postoperative Complications. Ann Plast Surg 2023; 90:33-40. [PMID: 36534098 DOI: 10.1097/sap.0000000000003386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results and cancer outcomes in the treatment of patients with macromastia or significant ptosis. This study evaluated a series of patients undergoing breast conservation with concomitant oncoplastic-augmentation-mastopexy and a contralateral augmentation-mastopexy. METHODS Patients undergoing lumpectomy for breast conservation were identified via a retrospective chart review. Inclusion criteria included patients with ptosis and preexisting breast implants or insufficient breast volume undergoing oncoplastic implant placement/exchange and mastopexy. Demographic characteristics, operative details, and complications were assessed. RESULTS Thirty-four consecutive patients (64 breasts, 4 unilateral procedures) were included in the study. Average age was 51.4 years, average body mass index was 27, and 38.2% were smokers/former smokers. The average operative time was 2.5 hours. Furthermore, 38.2% of patients received chemotherapy, and 82.4% of patients received breast adjuvant radiotherapy. The average length of follow-up was 11.7 months. In the sample that received radiation, the capsular contracture rate was 25%, with a 7.1% contracture revision rate. For the entire group, a total of 8 patients (23.5%) underwent revisions for either positive margins (8.8%), capsular contracture (8.8%), implant loss (2.9%), or cosmetic concerns (2.9%). One patient developed a pulmonary embolism. CONCLUSIONS Oncoplastic-augmentation-mastopexy is a safe technique with acceptable complication rates. This technique is best used for breast cancer patients with breast ptosis and a paucity of breast volume or preexisting implants who wish to pursue breast-conserving therapy. The revision rates are acceptable compared with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature, but patients must be clearly counseled on contracture risk.
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Affiliation(s)
- Harry M Salinas
- From the Department of Plastic and Reconstructive Surgery, Miami Cancer Institute at Baptist Health South Florida, Miami, FL
| | - Bar Y Ainuz
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Austin J Pourmoussa
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Eli B Levitt
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Aleeza Ali
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Antoun Bouz
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Matthew D Treiser
- From the Department of Plastic and Reconstructive Surgery, Miami Cancer Institute at Baptist Health South Florida, Miami, FL
| | - Miguel A Medina
- From the Department of Plastic and Reconstructive Surgery, Miami Cancer Institute at Baptist Health South Florida, Miami, FL
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Hammond JB, Foley BM, James S, Rebecca AM, Teven CM, Kruger EA, Kosiorek HE, Cronin PA, Bernard RW, Pockaj BA, Casey WJ. Does Prior Breast Augmentation Affect Outcomes After Mastectomy With Reconstruction? An Analysis of Postoperative Complications and Reoperations. Ann Plast Surg 2021; 86:508-511. [PMID: 33196535 DOI: 10.1097/sap.0000000000002583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate how prior breast augmentation impacts rates of complications and risk for reoperation after mastectomy with concurrent breast reconstruction. METHODS Patients undergoing nipple-sparing, skin-sparing, or simple mastectomy with implant-based reconstruction from 2008 to 2018 were identified in a prospective database. Postoperative complications and reoperations were then analyzed comparing patients with prior augmentation to patients without history of previous breast surgery. RESULTS A total of 468 patients were identified with a median follow-up of 4 years. Of these, 72 had prior augmentation mammoplasty. These patients underwent nipple-sparing (52, 72%), skin-sparing (15, 21%), or simple (5, 7%) mastectomy with immediate direct-to-implant (46, 61%) or tissue expander (26, 35%) reconstruction. On univariate analysis, this cohort had a lower body mass index (23.3 vs 25.3, P = 0.003), a higher rate of nipple-sparing mastectomy (72% vs 54%, P = 0.01), and a higher prevalence of stage I disease (44% vs 33%, P = 0.04). Differences in age, comorbidities, reconstructive techniques, tumor size, and neoadjuvant/adjuvant therapies were not significant. Overall complication rate between patients with or without prior augmentation did not significantly differ (51% vs 50%, P = 0.83); no significant differences in rates of surgical site infection, hematoma, mastectomy skin flap/wound necrosis, nipple complications, implant loss, or capsular contracture were found. Analysis of reoperations between patients with and without prior augmentation revealed no significant differences in average number of subsequent planned, unplanned, or total reoperations. On multivariate analysis, prior breast augmentation was found to be associated with significantly increased risk for undergoing ≥1 unplanned reoperation (odds ratio, 2.28; 95% confidence interval, 1.28-4.05, P = 0.005). CONCLUSIONS Prior augmentation mammoplasty does not significantly affect rates of postoperative complications after mastectomy with concurrent reconstruction. Although prior augmentation does not affect number of subsequent reoperations on average, it does increase the risk of experiencing 1 or more unplanned reoperation after mastectomy with reconstruction.
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Affiliation(s)
| | | | | | - Alanna M Rebecca
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix
| | - Chad M Teven
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix
| | - Erwin A Kruger
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix
| | - Heidi E Kosiorek
- Section of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Scottsdale
| | - Patricia A Cronin
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ
| | | | - Barbara A Pockaj
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ
| | - William J Casey
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix
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Lesniak DM, Millochau J, Wang KC, Atlan M, Otmezguine Y, Sarfati I, Nos C, Clough KB. Breast-conserving therapy can be offered to women with prior breast augmentation. Eur J Surg Oncol 2020; 46:1456-1462. [PMID: 32457015 DOI: 10.1016/j.ejso.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Breast cancer in women with cosmetic breast implants is increasingly common. Over the past decade, there has been a push for mastectomy and reconstruction in these patients, based on a fear of poor aesthetic results from small breast volume, and radiation-induced capsular contracture. At the Paris Breast Centre, augmented women routinely undergo lumpectomy with whole-breast irradiation (BCT). MATERIALS AND METHODS A consecutive cohort of 50 augmented women, who had attempted BCT for early breast cancer at our institution between 2003 and 2018, were retrospectively identified. Post-treatment complications, oncologic outcomes, capsular contracture rates, long-term cosmetic outcomes, and patient-reported outcomes were evaluated. RESULTS The median follow-up was 51 months. Margins were involved in 7 women (14%); 4 of whom underwent successful re-excision, and 3 had a mastectomy, for an early mastectomy rate of 6%. There were no early complications, nor cases of early implant loss. Long-term aesthetic results were evaluated using our 5-point scale: An excellent (5), or good (4) result was obtained in 68%. Significant capsular contracture (Baker grade 3 or 4) developed in 34%, of which, 5 women underwent capsulotomy and fat grafting; 4 of 5 downstaging their Baker grade. The estimated 5-year local recurrence rate was 2.3%. Ninety-five percent of participants would recommend BCT to augmented women. CONCLUSION BCT is feasible and safe in augmented women with good long-term aesthetic results, and should be considered to avoid unnecessary mastectomy.
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Affiliation(s)
- David M Lesniak
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Jenny Millochau
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Kuan-Chi Wang
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Michael Atlan
- Plastic and Reconstructive Surgery, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, France
| | - Yves Otmezguine
- Radiation Oncology, Centre Clinique de la Porte de Saint-Cloud, 30 rue de Paris, 92100, Boulogne, France
| | - Isabelle Sarfati
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Claude Nos
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Krishna B Clough
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France.
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Serritzlev MS, Lorentzen AK, Matthiessen LW, Hölmich LR. Capsular contracture in patients with prior breast augmentation undergoing breast conserving therapy and irradiation. J Plast Surg Hand Surg 2020; 54:225-232. [PMID: 32375532 DOI: 10.1080/2000656x.2020.1755299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Radiation is considered to be a risk factor for developing capsular contracture in augmented women, but the studies reporting on this subject show conflicting results. In this systematic review we sought to understand the risk of capsular contracture in augmented patients with breast cancer treated with breast conserving surgery and radiotherapy. A search was conducted through PubMed for studies reporting on breast cancer, breast augmentation and radiotherapy, with capsular contracture as our primary outcome. To determine if specific risk factors were significant predictors of the development of capsular contracture, we performed uni- and multivariate analysis. Our search revealed 136 articles, of which 12 were deemed eligible. A total of 237 patients were included in the analysis. Univariate analysis revealed that whole breast irradiation (WBI) was significantly associated with a higher risk of contracture (p < .001), compared to treatment with accelerated partial breast irradiation (APBI). A higher radiotherapy dose regimen was also significantly associated with a risk of capsular contracture (p < .001). When performing the multivariate analysis only the effect of increasing radiation dose remained significant (p < .05). Neither the implant location nor the age of the implant had any significant effect on the development of contracture. In conclusion this review shows that WBI is associated with a higher risk of contracture compared to treatment with APBI. Because of the limitations of the studies included, further studies with larger patient cohorts are needed to establish this correlation and evaluate other potential risk factors.
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Affiliation(s)
- Maja Schjølin Serritzlev
- Department of Plastic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Anne Kathrine Lorentzen
- Department of Plastic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Tadros AB, Moo TA, Zabor EC, Gillespie EF, Khan A, McCormick B, Cahlon O, Powell SN, Allen R, Morrow M, Braunstein LZ. Feasibility of Breast-Conservation Therapy and Hypofractionated Radiation in the Setting of Prior Breast Augmentation. Pract Radiat Oncol 2020; 10:e357-e362. [PMID: 32006728 DOI: 10.1016/j.prro.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/27/2019] [Accepted: 01/11/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Cosmetic outcomes and rate of implant loss are poorly characterized among patients with breast cancer with previous breast augmentation (BA) who undergo breast-conservation therapy (BCT). Here we determine capsular contracture and implant loss frequency after BCT among patients receiving contemporary whole-breast radiation therapy (RT). METHODS AND MATERIALS Patients with breast cancer with a history of BA presenting to our institution from January 2006 to January 2017 who elected for BCT were included. Seventy-one breast cancers in 70 patients with a history of BA electing for BCT were retrospectively identified. Clinicopathologic, treatment, and outcome variables were examined. Whole-breast RT included conventional and hypofractionated schedules with and without a boost. Rates of implant loss and cosmetic outcomes among patients who did and did not develop a new/worse contracture based on physician assessment were compared. RESULTS In the study, 54.9% of patients received radiation using hypofractionated whole-breast tangents; 81.7% received a boost. In addition, 18 out of 71 cases (25.4%) developed a new/worse contracture after BCT with a mean follow-up of 1.9 years. Furthermore, 9 out of 71 cases (12.7%) were referred to a plastic surgeon for revisional surgery. There were no implant-loss cases. On univariate analysis, implant location, time from implant placement to diagnosis, RT type, RT boost, body mass index, and tumor size were not associated with new/worse contracture. Of 12 patients with existing contracture, only 2 developed worsening contracture. Physician assessment of cosmetic outcome after BCT was noted to be excellent or good for 87.4% of patients. CONCLUSIONS BCT for breast cancer patients with prior history of BA has a low risk of implant loss. Hypofractionated RT does not adversely affect implant outcomes. Patients should be counseled regarding risk for capsular contracture, but the majority have good/excellent outcome; BA does not represent a contraindication to BCT.
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Affiliation(s)
- Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Atif Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert Allen
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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López-Prior V, Díaz-Expósito R, Casáns Tormo I. Influence of previous breast surgery in sentinel lymph node biopsy in patients with breast cancer. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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López-Prior V, Díaz-Expósito R, Casáns Tormo I. Influence of previous breast surgery in sentinel lymph node biopsy in patients with breast cancer. Rev Esp Med Nucl Imagen Mol 2017; 36:212-218. [PMID: 28359747 DOI: 10.1016/j.remn.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/07/2016] [Accepted: 11/28/2016] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to review the feasibility of selective sentinel lymph node biopsy in patients with previous surgery for breast cancer, as well as to examine the factors that may interfere with sentinel node detection. MATERIAL AND METHODS A retrospective review was performed on 91 patients with breast cancer and previous breast surgery, and who underwent sentinel lymph node biopsy. Patients were divided into two groups according to their previous treatment: aesthetic breast surgery in 30 patients (group I) and breast-conserving surgery in 61 (group II). Lymphoscintigraphy was performed after an intra-tumour injection in 21 cases and a peri-areolar injection in 70 cases. An analysis was made of lymphatic drainage patterns and overall sentinel node detection according to clinical, pathological and surgical variables. RESULTS The overall detection of the sentinel lymph node in the lymphoscintigraphy was 92.3%, with 7.7% of extra-axillary drainages. The identification rate was similar after aesthetic breast surgery (93.3%) and breast-conserving surgery (91.8%). Sentinel lymph nodes were found in the contralateral axilla in two patients (2.2%), and they were included in the histopathology study. The non-identification rate in the lymphoscintigraphy was 7.7%. There was a significantly higher non-detection rate in the highest histological grade tumours (28.6% grade III, 4.5% grade I and 3.6% grade II). CONCLUSION Sentinel lymph node biopsy in patients with previous breast surgery is feasible and deserves further studies to assess the influence of different aspects in sentinel node detection in this clinical scenario. A high histological grade was significantly associated with a lower detection.
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Affiliation(s)
- V López-Prior
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - R Díaz-Expósito
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España
| | - I Casáns Tormo
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España
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Single Institution Review of Patients With Prior Breast Augmentation Undergoing Breast Conservation Therapy for Breast Cancer. Ann Plast Surg 2017; 78:S289-S291. [PMID: 28328631 DOI: 10.1097/sap.0000000000001040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing number of patients with preexisting breast implants desire breast conservation therapy for breast cancer. There is paucity of comparative data on tumor margins and re-excisions in these patients. High re-excision rates up to 25% have been reported in breast conservation therapy patients; efforts to obtain cosmesis and avoid implant rupture might increase this further. We analyzed tumor margins, re-excision rates, and recurrence in previously augmented versus non-augmented patients undergoing lumpectomy for breast cancer. We preserved preexisting implants if feasible with oncologic clearance and cosmesis. METHODS Institutional review board-approved retrospective analysis was performed on patients undergoing lumpectomy with history of prior breast augmentation (N = 52) and consecutively selected non-augmented patients (N = 51). Based on tumor distance to inked margin, we grouped margins as negative (≥2 mm), close (<2 mm), and positive. Patients were followed up clinically and with imaging in the outpatient clinic, and recurrences were documented. RESULTS Patients in the non-augmented group were significantly more likely to have larger tumors (T2 and above; P = 0.05) compared with the augmented group. Although more patients in the augmented group had positive margins, this was not statistically significant (6 vs 3, P = 0.86). No difference was noted between re-excision rates among the augmented versus non-augmented groups (21.1% vs 19.6%, respectively; odds ratio, 0.91; 95% confidence interval, 0.35-2.37; P = 0.85); these remained unchanged even when adjusting for tumor stage (P = .75) and margins (P = 0.73). Although more patients in the augmented group recurred (4 vs 0), this was not statistically significant (P = 0.1). CONCLUSIONS Our results indicate that, from the oncological standpoint, patients with prior augmentation can undergo lumpectomy with equivalent tumor margins and re-excision rates. To the best of our knowledge, this is the first reported comparative study between these 2 groups.
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Munhoz AM, Gemperli R, Sampaio Goes JC. Transaxillary Subfascial Augmentation Mammaplasty with Anatomic Form-Stable Silicone Implants. Clin Plast Surg 2015; 42:565-84. [DOI: 10.1016/j.cps.2015.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sentinel lymph node biopsy in a patient with ruptured poly implant prothese (PIP) implants: A case report. Int J Surg Case Rep 2014; 5:992-4. [PMID: 25460455 PMCID: PMC4275806 DOI: 10.1016/j.ijscr.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022] Open
Abstract
We present the case of a lady with breast cancer requiring sentinel lymph node biopsy (SLNB) in the presence of ruptured PIP implants and imaging suggesting silicone granulomas. SLNB can be successful in the context of concurrent PIP implant rupture. SLNB as a procedure is possible in the presence of silicone granulomas in the axillary lymph nodes.
Introduction Around 400,000 silicone gel breast implants produced by the French company poly implant prothese (PIP) were used worldwide. Following revelations that the company were using non- medical grade silicone for the production of their implants there has been growing concern over the increased rupture rate of these implants and the implications this may have on patients. Presentation of Case We report the case of a 57-year old lady with ruptured bilateral cosmetic PIP breast implants in whom a right breast lesion was detected on screening mammograms. Biopsies demonstrated a grade 1 tubular carcinoma. Histology from the sentinel lymph node biopsy showed axillary silicone granulomas but no evidence of metastatic disease. Discussion To our knowledge, this is the first reported case to describe SLNB in the presence of ruptured PIP implants, although SLNB in ruptured non-PIP implants has been previously described. Conclusion We conclude that SLNB can be utilised even in the context of concurrent PIP implant rupture and the presence of silicone granulomas in the axillary lymph nodes.
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Alperovich M, Choi M, Frey JD, Karp NS. Reconstructive approach for patients with augmentation mammaplasty undergoing nipple-sparing mastectomy. Aesthet Surg J 2014; 34:1059-65. [PMID: 25028736 DOI: 10.1177/1090820x14541958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) is a recent advance in the therapeutic and prophylactic management of breast cancer; however, the procedure is associated with increased reconstructive complications. Data on NSM after previous breast augmentation are limited. OBJECTIVES The authors compared reconstructive complications after NSM between patients with previously augmented breasts and a larger cohort that had not undergone prior augmentation. An approach to NSM that involves 2-stage reconstruction in augmented patients is also described. METHODS Medical records of NSMs performed at New York University Langone Medical Center from 2006 to 2013 were reviewed. Data points evaluated included patient characteristics, comorbidities, breast implant plane, and reconstructive complications. Fisher's exact and t tests were used for the comparisons. RESULTS During the study period, NSMs were performed in 17 augmented breasts at this institution. After NSM, 15 of these breasts underwent implant-based reconstruction and 2 breasts underwent microvascular free flaps. Reconstructive complications included 1 hematoma managed nonoperatively (5.9%) and 1 partial necrosis of the nipple-areola complex (NAC) (5.9%). Compared with the larger nonaugmented cohort (n=332), patients with previously augmented breasts had fewer complications, and there were no statistically significant differences in the rates of mastectomy flap necrosis, partial NAC necrosis, complete NAC necrosis, hematoma, capsular contracture, explantation, implant displacement, seroma, or breast cellulitis. CONCLUSIONS The results indicate that NSM reconstruction is associated with minimal complications in patients with previous augmentation mammaplasty. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Michael Alperovich
- Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York
| | - Mihye Choi
- Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York
| | - Jordan D Frey
- Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York
| | - Nolan S Karp
- Dr Alperovich is a resident, Dr Choi is an assistant professor, Dr Frey is a resident, and Dr Karp is an associate professor in the Department of Plastic Surgery, New York University Medical Center, New York, New York
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Lei RY, Leonard CE, Howell KT, Henkenberns PL, Johnson TK, Hobart TL, Kercher JM, Widner JL, Kaske T, Barke LD, Carter DL. External beam accelerated partial breast irradiation yields favorable outcomes in patients with prior breast augmentation. Front Oncol 2014; 4:154. [PMID: 24995159 PMCID: PMC4062870 DOI: 10.3389/fonc.2014.00154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/03/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report outcomes in breast cancer patients with prior breast augmentation treated with external beam accelerated partial breast irradiation (EB-APBI) utilizing intensity-modulated radiotherapy or 3-dimensional conformal radiotherapy, both with IGRT. MATERIALS AND METHODS Sixteen stage 0/1 breast cancer patients with previous elective bilateral augmentation were treated post-lumpectomy on institutional EB-APBI trials (01185132 and 01185145 on clinicaltrials.gov). Patients received 38.5 Gy in 10 fractions over five consecutive days. Breast/chest wall pain and cosmesis were rated by patient; cosmesis was additionally evaluated by physician per RTOG criteria. RESULTS The median follow-up from accelerated partial breast irradiation (APBI) completion was 23.9 months (range, 1.2-58.6). Little to no change in cosmesis or pain from baseline was reported. Cosmetic outcomes at last follow-up were judged by patients as excellent/good in 81.2% (13/16), and by physicians as excellent/good in 93.8% (15/16). Ten patients (62.5%) reported no breast/chest wall pain, five (31.2%) reported mild pain, and one (6.2%) reported moderate pain. All patients remain disease free at last follow-up. The median ipsilateral breast, planning target volume (PTV), and implant volumes were 614, 57, and 333 cm(3). The median ratios of PTV/ipsilateral breast volume (implant excluded) and PTV/total volume (implant included) were 9 and 6%. CONCLUSION These 16 breast cancer cases with prior bilateral augmentation treated with EB-APBI demonstrate favorable clinical outcomes. Further exploration of EB-APBI as a treatment option for this patient population is warranted.
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Affiliation(s)
- Rachel Y Lei
- Radiation Oncology, Rocky Mountain Cancer Centers , Littleton, CO , USA ; Radiation Oncology, Rocky Mountain Cancer Centers , Aurora, CO , USA
| | - Charles E Leonard
- Radiation Oncology, Rocky Mountain Cancer Centers , Littleton, CO , USA
| | - Kathryn T Howell
- Radiation Oncology, Rocky Mountain Cancer Centers , Littleton, CO , USA
| | | | - Timothy K Johnson
- Radiation Oncology, Rocky Mountain Cancer Centers , Littleton, CO , USA
| | - Tracy L Hobart
- Radiation Oncology, Rocky Mountain Cancer Centers , Littleton, CO , USA
| | | | | | - Terese Kaske
- Invision Sally Jobe Diagnostic Breast Center , Greenwood Village, CO , USA
| | - Lora D Barke
- Invision Sally Jobe Diagnostic Breast Center , Greenwood Village, CO , USA
| | - Dennis L Carter
- Radiation Oncology, Rocky Mountain Cancer Centers , Aurora, CO , USA
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Sentinel lymph node biopsy following prior augmentation mammaplasty and implant rupture. J Plast Reconstr Aesthet Surg 2012; 65:e348-50. [PMID: 23047180 DOI: 10.1016/j.bjps.2012.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/10/2012] [Accepted: 09/10/2012] [Indexed: 11/21/2022]
Abstract
We report the case of a 44 year old lady with bilateral cosmetic silicone breast implants who had previously undergone a change of her right implant following extracapsular rupture. She presented 4 years later with a new lump in her right breast and underwent subcutaneous mastectomy for a grade 3 invasive ductal carcinoma. Sentinel lymph node biopsy demonstrated axillary silicone lymphadenopathy but nil evidence of metastatic disease. We present this as the first described case of successful sentinel lymph node biopsy in the context of prior augmentation mammaplasty and ipsilateral implant rupture with silicone lymphadenopathy.
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Mátrai Z, Gulyás G, Tóth L, Sávolt A, Kunos C, Pesthy P, Bartal A, Szabó E, Kásler M. [Special considerations in breast cancer treatment of an augmented breast]. Orv Hetil 2011; 152:1679-91. [PMID: 21979221 DOI: 10.1556/oh.2011.29189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet Általános és Mellkassebészeti Osztály Budapest Ráth György u. 7-9. 1122.
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Radiotracer visualization within a saline breast implant due to inadvertent needle penetration during lymphoscintigraphy. Clin Nucl Med 2011; 36:1023-4. [PMID: 21975393 DOI: 10.1097/rlu.0b013e318219b12a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nagao T, Hojo T, Kurihara H, Tsuda H, Tanaka-Akashi S, Kinoshita T. Sentinel lymph node biopsy in breast cancer patients with previous breast augmentation surgery. Breast Cancer 2011; 21:624-8. [PMID: 21671037 DOI: 10.1007/s12282-011-0280-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/13/2011] [Indexed: 02/07/2023]
Abstract
The number of breast augmentation surgeries (BAS) has increased. Therefore, the number of breast cancer patients with history of BAS has also increased. In this paper, we present two cases of sentinel lymph node biopsy (SLNB) in patients with previous BAS who were diagnosed with breast cancer. The patients were augmented using different approach; the first case was augmented through transaxillary incision, whereas the second case was augmented through periareolar incision. Lymphoscintigraphy (LPG) was performed on the patients 1 day prior to operation, enabling confirmation of lymphatic flow and SLN in both patients. SLNB was successfully performed in both cases. In one patient, SLNB was performed using indocyanine green (ICG) fluorescence and the Photodynamic Eye (PDE) system. Regardless of history of BAS, ICG and PDE system showed lymphatic flow and SLN in real time. LPG and ICG fluorescence were useful methods for SLN detection in patients with previous BAS, being able to confirm lymph flow before operation. Biopsy methods using LPG and PDE system were considered useful for difficult confirmation of lymph flow after breast augmentation. This is the first report of SLNB using ICG and PDE system for patients with previous BAS.
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Affiliation(s)
- Tomoya Nagao
- Department of Breast Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Leonard CE, Johnson T, Tallhamer M, Howell K, Kercher J, Kaske T, Barke L, Sedlacek S, Hobart T, Carter DL. Accelerated Partial Breast Intensity-Modulated Radiotherapy in Women Who Have Prior Breast Augmentation. Clin Breast Cancer 2011; 11:184-90. [DOI: 10.1016/j.clbc.2011.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 11/28/2022]
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21
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Tang SSK, Gui GPH. A Review of the Oncologic and Surgical Management of Breast Cancer in the Augmented Breast: Diagnostic, Surgical and Surveillance Challenges. Ann Surg Oncol 2011; 18:2173-81. [DOI: 10.1245/s10434-011-1578-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Indexed: 11/18/2022]
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22
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Kiluk JV, Kaur P, Meade T, Ramos D, Morelli D, King J, Cox CE. Effects of Prior Augmentation and Reduction Mammoplasty to Sentinel Node Lymphatic Mapping in Breast Cancer. Breast J 2010; 16:598-602. [DOI: 10.1111/j.1524-4741.2010.00989.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Cheng G, Kurita S, Torigian DA, Alavi A. Current status of sentinel lymph-node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging 2010; 38:562-75. [PMID: 20700739 DOI: 10.1007/s00259-010-1577-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 07/18/2010] [Indexed: 12/17/2022]
Abstract
Axillary node status is the most important prognostic indicator for patients with invasive breast cancer. Sentinel lymph-node biopsy (SLNB) is widely accepted and the preferred procedure for identifying lymph-node metastasis. SLNB allows focused excision and pathological examination of the most likely axillary lymph nodes to receive tumor metastases while avoiding morbidities associated with complete axillary nodal dissection. Since its introduction in the early 1990s, the process of SLNB has undergone continual modification and refinement; however, the procedure varies between institutions and controversies remain. In this review, we examine the technical issues that influence the success of lymph node mapping, discuss the controversies, and summarize the indications and contraindications for axillary node mapping and biopsy in clinical practice.
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Affiliation(s)
- Gang Cheng
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Ansari B, Boughey JC. Sentinel Lymph Node Surgery in Uncommon Clinical Circumstances. Surg Oncol Clin N Am 2010; 19:539-53. [DOI: 10.1016/j.soc.2010.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Surgeons retain the central role in the multidisciplinary care of the breast cancer patient. While technical details of the operations for these patients remain important, effective evidence-based decision making may be even more so. Advances in the methods of breast cancer diagnosis, localization techniques and surgical therapies, as well as the expanded role of the surgeon in breast cancer prevention, radiation therapy and the treatment of distant disease, requires surgeons to stay up to date with the available evidence. Herein, we present a review of the current surgical therapy of invasive breast cancer.
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Affiliation(s)
- Barbara A Pockaj
- Section of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA.
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Cheng NX, Liu LG, Hui L, Chen YL, Xu SL. Breast cancer following augmentation mammaplasty with polyacrylamide hydrogel (PAAG) injection. Aesthetic Plast Surg 2009; 33:563-9. [PMID: 19156460 DOI: 10.1007/s00266-008-9298-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
Polyacrylamide hydrogel (PAAG) as an implanted material for augmentation mammaplasty has been used for years in China. Many kinds of complications associated with PAAG use have been reported in the clinical literature. This report presents two cases of breast cancer occurring after injection of PAAG in augmented breasts. The delayed diagnosis and more aggressive disease due to PAAG injection should be cause for concern. It is very important to detect breast cancer early when it is covered by the induration of the injected gel and inflammation reaction after PAAG injection. PAAG injection for augmentation mammaplasty may affect the outcome of breast cancer diagnosis and prognosis.
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Sentinel lymph node detection and evidence of axillary lymphatic integrity after transaxillary breast augmentation: a prospective study using lymphoscintography. Aesthetic Plast Surg 2008; 32:879-88. [PMID: 18661171 DOI: 10.1007/s00266-008-9212-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG). METHODS Twenty patients (40 breasts) who underwent TBA were evaluated by LSG immediately after periareolar injections of phytate-99 mTc at three time points: before TBA (Pre-LSG) and approximately 30 days (Recent-Post-LSG) and 6 months after TBA (Late-Post-LSG). Statistical analysis considered p \ 0.05 significant, or p \ 0.017 when Bonferroni correction was applied. RESULTS All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between Pre-LSG and Recent-Post-LSG (p = 1), Pre-LSG and Late-Post-LSG (p = 0.625), and Recent-Post-LSG and Late-Post-LSG (p = 0.625). The average number of hot SN was 1.28 in Pre-LSG, 1.10 in Recent-Post-LSG, and 1.23 in Late-Post-LSG, without significant differences (p = 0.202). The average time of the first SN appearance was not significantly different (p = 0.186). Analysis of SN uptake percentage showed a significant difference between Pre-LSG and Recent-Post-LSG (p = 0.009), with a reduction of drainage magnitude in Recent-Post-LSG. CONCLUSION The preservation of axillary lymphatic drainage after TBA allowed for SN detection in all studied breasts. It seems that the applied surgical technique played an important role in axillary lymphatic integrity.
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White JR, Halberg FE, Rabinovitch R, Green S, Haffty BG, Solin LJ, Strom EA, Taylor ME, Edge SB. American College of Radiology appropriateness criteria on conservative surgery and radiation: stages I and II breast carcinoma. J Am Coll Radiol 2008; 5:701-13. [PMID: 18514949 DOI: 10.1016/j.jacr.2008.02.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND During the past 2 decades, breast conservation therapy (BCT) has become firmly established as a standard therapeutic approach for eligible women with early-stage breast cancer. Breast radiation after conservative surgery is an integral component of BCT, resulting in comparable local control and equivalent survival to mastectomy. Successful breast conservation relies on understanding key elements for patient selection, evaluation, treatment contraindications, radiation therapy methods, and integration with systemic therapy. METHODS The Appropriateness Criteria Committee of the American College of Radiology convened an expert panel to examine BCT for early-stage breast cancer. By using a modified Delphi technique to generate consensus, the expert panel responded to questionnaires on 9 clinical cases that address various key elements of breast conservation. A literature review on BCT led to the generation of an evidence table to support the consensus and overview. RESULTS Consensus for appropriateness criteria for BCT was produced for various clinical scenarios commonly encountered in practice. These topics include radiation oncology management issues related to young patient age, sentinel node biopsy, elderly patients, other histology, positive margins, extensive intraductal component, node-positive breast cancer, genetic breast cancer, partial breast irradiation, and systemic therapy. Radiation methods for BCT are reviewed. CONCLUSION The Breast Cancer Panel has generated a consensus of up-to-date guidelines for the appropriate use of radiation for BCT by using a modified Delphi process for the American College of Radiology Appropriateness Criteria.
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Affiliation(s)
- Julia R White
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226-4801 , USA.
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Kaminski A, Amr D, Kimbrell ML, Difronzo LA. Lymphatic Mapping in Patients with Breast Cancer and Previous Augmentation Mammoplasty. Am Surg 2007. [DOI: 10.1177/000313480707301011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is now an established method of axillary staging in patients with breast cancer. However, the augmented breast poses an interesting challenge to this procedure. We hypothesized that SLNB is feasible in patients with augmented breasts who subsequently develop breast cancer. A retrospective study was performed from 1995 to 2006. Ten patients with augmented breasts underwent breast conservation therapy with SLNB. Sentinel lymph nodes were identified in all 10 patients. Three patients had positive sentinel nodes. Two patients proceeded to axillary lymph node dissection (ALND), and one declined. The subsequent ALND were negative for metastatic cancer. Seven patients had negative sentinel nodes. One patient with a negative sentinel node underwent ALND with all nodes negative for metastasis. Two patients were lost to follow-up. Of the remaining eight patients, the mean duration of follow-up was 71 months. None of these patients had evidence of axillary recurrence or distant metastasis at time of last follow-up. SLNB is a feasible method of axillary node staging in patients who have undergone augmentation mammoplasty who subsequently develop breast cancer. Further studies are needed to better determine the accuracy of lymphatic mapping in this patient population.
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Affiliation(s)
- Anna Kaminski
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Dena Amr
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | | | - L. Andrew Difronzo
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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Graf R, Sado H. Transaxillary Breast Augmentation: Two Breast Cancer Patients with Successful Sentinel Lymph Node Diagnosis. Aesthetic Plast Surg 2007. [DOI: 10.1007/s00266-007-0035-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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McIntosh SA, Horgan K. Breast cancer following augmentation mammoplasty - a review of its impact on prognosis and management. J Plast Reconstr Aesthet Surg 2007; 60:1127-35. [PMID: 17613294 DOI: 10.1016/j.bjps.2007.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 09/28/2006] [Accepted: 03/20/2007] [Indexed: 11/29/2022]
Abstract
The incidence of breast cancer in women with implants is increasing and will continue to do so for the foreseeable future due to the marked increase in breast implant insertion in recent years. Undoubtedly many of these women will wish to know whether the presence of implants worsens the prognosis of their breast cancer. Furthermore, the clinical management of such patients may be difficult, as aesthetic results are likely to be a major concern for women who have already undergone cosmetic surgery to the breast. There is no consensus on surgical approach to this scenario. This article reviews the literature on the prognosis of breast cancer patients with a history of augmentation mammoplasty and examines the available data regarding their surgical treatment.
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Affiliation(s)
- S A McIntosh
- Department of Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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Graf RM, Canan LW, Romano GG, Tolazzi ARD, Cruz GADOE. Re: implications of transaxillary breast augmentation: lifetime probability for the development of breast cancer and sentinel node mapping interference. Aesthetic Plast Surg 2007; 31:322-4. [PMID: 17576508 DOI: 10.1007/s00266-006-0204-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ruth M Graf
- Division of Plastic Surgery, Hospital de Clinicas, School of Medicine, Federal University of Parana, Curitiba-PR, Brazil.
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Boughey JC, Hunt KK. Expanding the indications for sentinel lymph node surgery in breast cancer. Future Oncol 2007; 3:9-14. [PMID: 17280496 DOI: 10.2217/14796694.3.1.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Munhoz AM, Aldrighi C, Ono C, Buchpiguel C, Montag E, Fells K, Arruda E, Gemperli R, Aldrighi JM, Ferreira MC. The Influence of Subfascial Transaxillary Breast Augmentation in Axillary Lymphatic Drainage Patterns and Sentinel Lymph Node Detection. Ann Plast Surg 2007; 58:141-9. [PMID: 17245139 DOI: 10.1097/01.sap.0000237762.99536.77] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The transaxillary approach plays a useful role for breast augmentation due to scar placement in a less visible position. However, the future impact of the procedure on the lymphatic drainage patterns and sentinel lymph node (SLN) detection remains controversial. To date, no information is available regarding the feasibility of SLN identification in patients with previous transaxillary breast augmentation (TBA). METHODS Twenty-six patients underwent primary TBA. Mean follow-up was 8.3 months. All patients were submitted to lymphoscintigraphy (LSG), with a dose of 0.1 mCi 99m-technetium-labeled dextran 1 week before (preop-LSG) and 10 days (Po10 days-LSG) after TBA. RESULTS Preop-LSG was successful in all patients. Mean number of SLN detected was 2 per patient (range, 1 to 4) in the right axilla and 2.2 (range, 1 to 5) in the left. In Po10 days-LSG, SLN detection was successful in 92.3%. Mean number of SLN detected was 2.3 per patient (range, 0 to 7) in the right axilla and 1.8 (range, 0 to 6) on the left. Two patients (7.6%) failed to reveal the accumulation of radioactivity in Po10 days-LSG. Comparing bilaterally, in the number of SLN detected (P = 0.838) and the SLN uptake (P = 0.067) between Preop-LSG and Po10 days-LSG, no significant differences were observed. No major complication was noted. CONCLUSION The initial data illustrate that SLN detection in the setting of prior TBA is feasible in a great part of patients. Additional long-term studies are necessary to investigate the accuracy of SLN biopsy in subgroups of breast cancer patients with previous breast implants.
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McCarthy CM, Pusic AL, Disa JJ, Cordeiro PG, Cody HS, Mehrara B. Breast Cancer in the Previously Augmented Breast. Plast Reconstr Surg 2007; 119:49-58. [PMID: 17255656 DOI: 10.1097/01.prs.0000244748.38742.1f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast cancer in a previously augmented breast raises questions regarding cancer detection and staging, surgical and adjuvant treatment options, reconstructive outcomes, management of the contralateral breast, and continued breast cancer surveillance. This article explores the oncologic and reconstructive issues relevant to women desiring cosmetic breast implants and women with breast cancer who have undergone prior cosmetic breast augmentation.
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Affiliation(s)
- Colleen M McCarthy
- New York, N.Y. From the Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center
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Boughey JC, Khakpour N, Meric-Bernstam F, Ross MI, Kuerer HM, Singletary SE, Babiera GV, Arun B, Hunt KK, Bedrosian I. Selective use of sentinel lymph node surgery during prophylactic mastectomy. Cancer 2006; 107:1440-7. [PMID: 16955504 DOI: 10.1002/cncr.22176] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with invasive cancer identified at the time of prophylactic mastectomy (PM) will require axillary lymph node dissection for staging; therefore, many surgeons advocate sentinel lymph node (SLN) surgery at the time of PM. The current study investigates the invasive cancer rate in PM and evaluates factors associated with invasive cancer to guide SLN surgery use. METHODS Patients undergoing PM at the M. D. Anderson Cancer Center between January 2000 and July 2005 were identified from a prospective database. Clinical, radiographic, and pathologic data were collected. RESULTS A total of 409 patients (436 PM cases) were identified; 382 underwent contralateral PM (CPM) and 27 underwent bilateral PM (BPM). Cancer was identified in 22 of 436 PM cases (5%). Of these, 14 patients (64%) had ductal carcinoma in situ (DCIS). Only 8 patients (1.8%) had invasive cancer, with a mean tumor size of 5 mm (range, 2-9 mm). There was no difference in the occult cancer rate between CPM and BPM. No cases of invasive cancer were identified in the 23 patients with BRCA mutations. Significantly increased risk of invasive cancer in the PM breast was seen in postmenopausal patients (3.7%; P = .007), patients age >60 years (7.5%; P = .008), and patients with history of invasive lobular carcinoma (9.7%; P = .0002) or lobular carcinoma in situ (LCIS) (7.7%; P = .008). CONCLUSIONS The frequency of cancer in PM is very low and the majority represents DCIS. Therefore, routine use of SLN surgery in all patients undergoing PM is not warranted. However, patients at higher risk for whom SLN surgery should be considered include older women and patients with a history of lobular cancer or LCIS.
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Affiliation(s)
- Judy C Boughey
- Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Munhoz AM, Fells K, Arruda E, Montag E, Okada A, Aldrighi C, Aldrighi JM, Gemperli R, Ferreira MC. Subfascial transaxillary breast augmentation without endoscopic assistance: technical aspects and outcome. Aesthetic Plast Surg 2006; 30:503-12. [PMID: 16977363 DOI: 10.1007/s00266-006-0017-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although transaxillary breast augmentation (TBA) is a well-studied procedure, few previous reports exist concerning the subfascial technique, especially without endoscopic assistance. This study aimed to analyze the feasibility of the technique after breast augmentation in terms of its indication, surgical technique, limitations, and clinical outcome. METHODS For this study, 42 patients underwent TBA without endoscopic assistance. The technique was indicated for patients with breasts of small or moderate volume without ptosis, patients who wanted no breast scars, and patients who had a poorly defined inframammary fold. The mean follow-up period was 16 months. Implant and incision approach complications were evaluated. Information on patient satisfaction was collected. RESULTS A total of 14 complications occurred in 42 patients, all of them minor. Axillary incision-related complications occurred in 26% of the patients, as represented by a late axillary subcutaneous band (119%), sensory loss in the inner aspect of the arm (71%), and a hypertrophic scar and small wound dehiscence (71%). No patient presented with capsular contracture, visible rippling, or infection. Most of the patients (93%) were either very satisfied or satisfied with their result, and none regretted the surgery. CONCLUSION The TBA procedure without endoscopic assistance is a simple and reliable technique for breast augmentation. Most of the complications in this study were minor and predictable. They did not interfere with the aesthetic outcome nor the normal postoperative recovery. With TBA, success depends on patient selection as well as careful intra- and postoperative management.
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Affiliation(s)
- Alexandre M Munhoz
- Division of Plastic Surgery, University of São Paulo School of Medicine, Rua da Consolação 3605 ap 91, 01416-001 São Paulo, SP, Brazil.
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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. [PMID: 16848844 DOI: 10.1111/j.1075-122x.2006.00273.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Augmentation mammaplasty is rapidly becoming one of the most frequently performed cosmetic surgeries. However, as the augmented patient population ages, major concerns associated with the screening, diagnosis and treatment of breast cancer are being realized. Although current evidence convincingly indicates that breast implants do not play a role in inducing localized or systemic disease, particularly breast cancer, recent studies have shown implants not only reduce the sensitivity of mammography, but interfere with mammographic detection, possibly leading to delayed breast cancer diagnosis. In addition, the risk for local recurrence, as well as unfavorable cosmetic results, breast fibrosis, and capsular contracture following radiation therapy as part of breast-conserving therapy in previously augmented patients are of great concern. Given the overall lack of treatment consensus, paucity of literature, and increasing number of augmented breast cancer patients, we provide a retrospective review of the diagnosis, treatment, and follow-up of 12 augmented patients from 1998 to 2004 who developed breast cancer. Eight of 12 augmented patients presented with a palpable mass on physical examination, which prompted further mammographic evaluation. Abnormalities in the remaining four individuals were detected on routine mammographic screening. Pathology staging results were available for all 12 patients. Breast-conserving therapy was used to treat six patients and adequate negative pathologic margins were obtained in all patients. The remaining six patients were treated with mastectomy due to multifocal disease, inadequate margins, or proximity to the implant capsule. Thus far, one patient has had local recurrence and one patient has had distant recurrence after initial surgery. No evidence of local or systemic recurrence, infection, contracture, poor cosmetic outcome, or other complications has been detected in the remaining 10 patients as of the most recent follow-up. Based on this small cohort of augmented women, the presence of implants led to an increased proportion of palpable tumors, in spite of routine screening mammography. Consistent with other studies, although our results suggest a tendency toward delayed diagnosis in augmented women relative to age-matched controls, this did not appear to influence the overall prognosis.
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Affiliation(s)
- Richard Tuli
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Krynyckyi BR, Shafir MK, Kim SC, Kim DW, Travis A, Moadel RM, Kim CK. Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:25. [PMID: 16277655 PMCID: PMC1308847 DOI: 10.1186/1477-7800-2-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 12/28/2022]
Abstract
Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).
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Affiliation(s)
- Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Michail K Shafir
- Department of Surgery, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Dong Wook Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Arlene Travis
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Renee M Moadel
- Department of Nuclear Medicine, Albert Einstein College of Medicine of Yeshiva University, and the Montefiore Medical Center, Bronx, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
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Meunier A, Tristant H, Sinna R, Delay E. [Mammary implants and breast cancer]. ANN CHIR PLAST ESTH 2005; 50:595-604. [PMID: 16169139 DOI: 10.1016/j.anplas.2005.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 07/22/2005] [Indexed: 11/29/2022]
Abstract
Many publications deal with the impact of cosmetic breast implants to increase the breast cancer occurence or to delay its diagnosis. We first try to express the clinical and radiological differences in the implanted breast. The diagnostical and therapeutical difficulties were developped to the different technics of imagery, biopsy and specific management of the treatment. On one hand, the litterature revue does not show any significant difference in tumoral stage and nodal status between augmented and nonaugmented women eventhough the mammography sensibility is not as optimal. On the other hand, the global mortality of the augmented population is higher but it appears that this phenomenon could be link to their way of life and is totally independant of breast cancer. Finally, if the diagnosis and the treatment are more complex, the women survival is not altered by breast augmented surgery.
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Affiliation(s)
- A Meunier
- Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France.
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McMasters KM. What's new in surgical oncology. J Am Coll Surg 2005; 201:449-53. [PMID: 16125080 DOI: 10.1016/j.jamcollsurg.2005.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 05/12/2005] [Indexed: 12/01/2022]
Affiliation(s)
- Kelly M McMasters
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Munhoz AM, Aldrighi C, Buschpiegel C, Ono C, Montag E, Fells K, Arruda E, Sturtz G, Kovac P, Filassi JR, Gemperli R, Ferreira MC. The feasibility of sentinel lymph node detection in patients with previous transaxillary implant breast augmentation: preliminary results. Aesthetic Plast Surg 2005; 29:163-8. [PMID: 15959693 DOI: 10.1007/s00266-004-0103-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transaxillary breast augmentation has gained popularity because of the good aesthetic results and scar placement in a less visible position. As breast-augmented patients age, an increasing number of breast cancer cases can be expected. Sentinel lymph node detection (SLND) is a well-established technique in breast cancer. To date, no information is available regarding the feasibility of SLND for patients with previous transaxillary implants. METHODS A 28-year-old women with bilateral breast hypoplasia underwent a bilateral breast augmentation by the transaxillary approach. One week earlier, SLND was accomplished through two periareolar injections of 0.1 mCi 99m-technetium-labeled fitate and lymphoscintigraphy. A 3.5-cm-long axillary incision was performed, and the dissection continued through the subfascial plane to create the implant's pocket. A silicone gel implant (215 g round, low-profile, textured Silimed) was inserted. RESULTS A satisfactory aesthetic result was obtained. Two postoperative lymphoscintigraphies were performed (15 days and 7 months after surgery) with satisfactory SLND. No complication was noted. CONCLUSION The initial data show that SLND in the setting of prior breast implant augmentation through the transaxillary approach is feasible. Additional prospective studies and larger clinical series are necessary to analyze the accuracy of SLND for patients with previous breast implants.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- Division of Plastic Surgery, University of São Paulo School of Medicine, Rua Oscar Freire 1702 ap 78, Sao Paulo, SP, 05409-011, Brazil.
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