Feasibility of Breast-Conservation Therapy and Hypofractionated Radiation in the Setting of Prior Breast Augmentation.

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.

• Authors: Audree B Tadros, Tracy-Ann Moo, Emily C Zabor, Erin F Gillespie, Atif Khan, Beryl McCormick, Oren Cahlon, Simon N Powell, Robert Allen Jr, Monica Morrow, Lior Z Braunstein
• Journal: Practical radiation oncology (Pract Radiat Oncol) 2020 Sep - Oct Vol. 10 Issue 5 Pg. e357-e362 ISSN: 1879-8519 [Electronic] United States
• PMID: 32006728 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Breast Implants (adverse effects)
• Breast Neoplasms (radiotherapy, surgery)
• Feasibility Studies
• Humans
• Mastectomy, Segmental
• Middle Aged
• Retrospective Studies
• Treatment Outcome