BREAST-CONSERVING SURGERY AND RADIATION AFTER AUGMENTATION MAMMAPALSTY

Background. Although breast-conserving therapy (tumor excision, axilla ry node dissection, and postoperative radiation) for women with breast cancer yields sur: vival and local recurrence rates comparable with t hose of modified radical mastectomy, studies suggest that postoperativ e radiation leads to-capsular contractures and poor cosmesis in patien ts with breast implants. Methods. The authors followed 20 women in who m breast cancer developed after augmentation mammoplasty (14 subcutane ous implants and 6 retromuscular implants). Average age at diagnosis w as 52 years (range, 34-72 years). Most (55%) of the patients had tumor s in the upper outer quadrant. Fifteen lesions were palpable and five were nonpalpable. All tumors were excised using wide margins that atte mpted to include a rim of normal breast tissue. Three patients had mic roscopically positive margins. The predominant histology was ductal ad enocarcinoma (85%). The mean greatest tumor dimension was 1.43 cm; 75% were T1 lesions. Levels I and II axillary lymph node dissection revea led metastases in five patients. After surgery, six patients received systemic chemotherapy, and all patients received 4500-5000 cGy of tang ential,photon radiation delivered to the whole breast, plus a 1400-210 0 cGy boost delivered to the tumor site using photon radiation, electr on radiation, or iridium 192 implantation. Results. At a median follow -up of 3.8 years (range, 6 months to 9.3 years), there were no local r ecurrences; however, in two patients distant metastases developed. Sev enteen (85%) of the twenty patients had good or excellent cosmetic res ults as determined by the degree of capsular contracture, breast shape and appearance, and the presence of skin changes. Conclusions. The au thors conclude that breast-conserving therapy is a cosmetically accept able therapeutic option for women in whom breast cancer develops after augmentation mammoplasty.