Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Breast Cancer Following Augmentation Mammoplasty: A Case Control Study.
Michael Sosin, M.D.1, Chaitan Devulapalli, M.D.1, Charles Fehring, M.D.2, Edward R. Hammond, M.D.,M.P.H.,Ph.D.3, Shawna C. Willey, M.D.1, Scott L. Spear, M.D.1, Elizabeth D. Feldman, M.D.4.
1Medstar Georgetown University Hosptial, Washington, DC, USA, 2Medical College of Wisconsin, Milwaukee, WI, USA, 3The Johns Hopkins School of Medicine, Baltimore, MD, USA, 4Reston Hospital Center, Reston, VA, USA.

Purpose: The purpose of this study was to determine whether augmentation mammaplasty affects breast cancer detection, staging, and treatment.
Methods: Following IRB approval, from January 2000 to January 2013 cases were identified as patients with previous breast augmentation who developed breast cancer. A randomized control group of 5-10 age- and race-matched breast cancer controls were identified per case (from the affiliated institutional cancer center). All data was retrospectively reviewed for implant details (age, anatomic location, and fill type), histology, staging, method of detection, and treatment. Pearson chi-square analysis, one-way ANOVA, and Wilcoxon rank-sum (Mann-Whitney) test were applied for
statistical analysis.
Results: A total of 48 cases and 302 controls were included in the study. Breast cancer histology, receptor status, and BRCA1/2 status were comparable in both groups (Table 1). All palpable lesions were detected at a smaller size in augmented patients (1.6 ± 0.8cm vs. 2.3 ± 1.6cm, (p<0.001). Augmented patients presented with a physical finding in 54.2% vs. 50.4% in controls and were found on breast imaging in 45.8% of case vs. 49.6% of controls (p=0.738). Lesions in augmented patients were detectable in 77.8% of cases on screening mammography vs. 90.7% in controls (p=0.010) with comparable BIRADS findings (3.96 vs. 3.96, respectively). Patient with breast implants were more likely to undergo an excisional biopsy (20.5% vs. 4.4%, p<0.001) and less likely to undergo core needle biopsy (77.3% vs. 95.3%, p<0.001). Earlier staging in augmented patients approached but did not reach statistical significance (Table 1, p=0.073). Augmented patients had a higher mastectomy rate and a lower rate of breast conservation therapy (74.5% vs. 57.0% and 25.5% vs. 43%, respectively, p=0.023). Mean duration of implants was 14.1 ± 9.7 years. Subgroup analysis revealed implant fill type and anatomic location did not significantly differ in their affect on outcomes (Table 1).
Conclusion: This is a larger, contemporary study of breast cancer following augmentation mammaplasty demonstrating that breast implants can lead to earlier detection of breast cancer but is susceptible to being missed on screening mammography despite modern mammographic techniques. Patients with implants are more likely to undergo more aggressive measures such as an excisional biopsy rather than core needle biopsy and are more likely to receive a mastectomy rather than breast conservation therapy. Implant fill type (silicone vs. saline) and anatomic location (subglandular vs. subpectoral) have comparable affects on breast
imaging, biopsy, and surgery.


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