Breast cancer after augmentation mammaplasty: Treatment by skin-sparing mastectomy and immediate reconstruction

Grant W. Carlson, Bridgett Moore, James F. Thornton, Mark Elliott, Glyn Bolitho

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Breast conservation has been associated with poor cosmetic outcome when used to treat breast cancer in patients who have undergone prior augmentation mammaplasty. Radiation therapy of the augmented breast can increase breast fibrosis and capsular contraction. Skin-sparing mastectomy and immediate reconstruction are examined as an alternative treatment. Six patients with prior breast augmentation were treated for breast cancer by skin-sparing mastectomy and immediate reconstruction. One patient underwent a contralateral prophylactic skin-sparing mastectomy. Silicone gel implants had been placed in the submuscular location in five patients and in the subglandular position in one patient a mean of 10.2) years (range, 6 to 20 years) before breast cancer diagnosis. The mean patient age was 41.3, years (range, 33 to 56 years). Four independent judges reviewed postoperative photographs to grade the aesthetic results in comparison with the opposite native or reconstructed breast. The American Joint Committee on Cancer staging was stage 0 in one patient, stage I for four patients, and stage 11 for one patient. Five of the six patients presented with a palpable breast mass. Latissimus dorsi flap reconstruction was performed in four patients (bilaterally in one) and a transverse rectus abdominis muscle (TRAM) flap was used in two patients. Three patients were treated by skin-sparing mastectomy with preservation of the breast implant (two patients with latissimus flaps, and one patient with a TRAM flap). The tumor location necessitated the femoral of implants in two patients (one patient with a latissimus flap and one with a TRAM. A saline implant was placed under the latissimus flap after gel implant removal. The patient who underwent bilateral skin-sparing mastectomies desired explantation and placement of saline implants. No remedial surgery was performed on the opposite breast to achieve symmetry. Complications occurred in two patients at the latissimus dorsi donor site (seroma in one patient, and seroma and infection in one). Five patients underwent complete nipple reconstructions. The mean duration of follow-up was 33.6 months (range, 15.5 to 70.3 months), and there were no recurrences of breast cancer. The aesthetic results were judged to be good to excellent in all cases. Skin-sparing mastectomy and immediate reconstruction can be used in patients with prior breast augmentation, with good to excellent cosmetic results. Depending on the tumor and implant location, the implant may be preserved without compromising local control.

Original languageEnglish (US)
Pages (from-to)687-692
Number of pages6
JournalPlastic and Reconstructive Surgery
Volume107
Issue number3
StatePublished - 2001

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Mammaplasty
Mastectomy
Breast Neoplasms
Skin
Breast
Therapeutics
Rectus Abdominis
Seroma
Superficial Back Muscles
Esthetics
Cosmetics
Muscles
Silicone Gels
Breast Implants

ASJC Scopus subject areas

  • Surgery

Cite this

Breast cancer after augmentation mammaplasty : Treatment by skin-sparing mastectomy and immediate reconstruction. / Carlson, Grant W.; Moore, Bridgett; Thornton, James F.; Elliott, Mark; Bolitho, Glyn.

In: Plastic and Reconstructive Surgery, Vol. 107, No. 3, 2001, p. 687-692.

Research output: Contribution to journalArticle

Carlson, Grant W. ; Moore, Bridgett ; Thornton, James F. ; Elliott, Mark ; Bolitho, Glyn. / Breast cancer after augmentation mammaplasty : Treatment by skin-sparing mastectomy and immediate reconstruction. In: Plastic and Reconstructive Surgery. 2001 ; Vol. 107, No. 3. pp. 687-692.
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abstract = "Breast conservation has been associated with poor cosmetic outcome when used to treat breast cancer in patients who have undergone prior augmentation mammaplasty. Radiation therapy of the augmented breast can increase breast fibrosis and capsular contraction. Skin-sparing mastectomy and immediate reconstruction are examined as an alternative treatment. Six patients with prior breast augmentation were treated for breast cancer by skin-sparing mastectomy and immediate reconstruction. One patient underwent a contralateral prophylactic skin-sparing mastectomy. Silicone gel implants had been placed in the submuscular location in five patients and in the subglandular position in one patient a mean of 10.2) years (range, 6 to 20 years) before breast cancer diagnosis. The mean patient age was 41.3, years (range, 33 to 56 years). Four independent judges reviewed postoperative photographs to grade the aesthetic results in comparison with the opposite native or reconstructed breast. The American Joint Committee on Cancer staging was stage 0 in one patient, stage I for four patients, and stage 11 for one patient. Five of the six patients presented with a palpable breast mass. Latissimus dorsi flap reconstruction was performed in four patients (bilaterally in one) and a transverse rectus abdominis muscle (TRAM) flap was used in two patients. Three patients were treated by skin-sparing mastectomy with preservation of the breast implant (two patients with latissimus flaps, and one patient with a TRAM flap). The tumor location necessitated the femoral of implants in two patients (one patient with a latissimus flap and one with a TRAM. A saline implant was placed under the latissimus flap after gel implant removal. The patient who underwent bilateral skin-sparing mastectomies desired explantation and placement of saline implants. No remedial surgery was performed on the opposite breast to achieve symmetry. Complications occurred in two patients at the latissimus dorsi donor site (seroma in one patient, and seroma and infection in one). Five patients underwent complete nipple reconstructions. The mean duration of follow-up was 33.6 months (range, 15.5 to 70.3 months), and there were no recurrences of breast cancer. The aesthetic results were judged to be good to excellent in all cases. Skin-sparing mastectomy and immediate reconstruction can be used in patients with prior breast augmentation, with good to excellent cosmetic results. Depending on the tumor and implant location, the implant may be preserved without compromising local control.",
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