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

Breast conservation has been associated with poor cosmetic outcome when use d to treat breast cancer in patients who have undergone prior augmentation mammaplasty. Radiation therapy, of the augmented breast can increase breast fibrosis acid 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 underw ent a contralateral prophylactic skin-sparing mastectomy. Silicone gel impl ants had been placed in the submuscular location in five patients and in th e 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 ph otographs to grade the aesthetic results in comparison with the opposite na tive or reconstructed breast. The American Joint Committee on Cancer staging was stage 0 in one patient, stage I for four patients, and stage II for one patient. Five of the six pa tients presented with a palpable breast mass. Latissimus dorsi flap reconst ruction was performed in four patients (bilaterally ill one) and a transver se rectus abdominis muscle (TRAM) flap was used in two patients. Three pati ents were treated by skin-sparing mastectomy with preservation of the breas t implant (two patients with latissimus flaps, and one patient with a TRAM flap). The tumor location necessitated the removal of implants in two patie nts tone patient with a latissimus flap and one with a TRAM. A saline impla nt was placed under the latissimus flap after gel implant removal. The pati ent who underwent bilateral skill-sparing mastectomies desired explantation and placement of saline implants. No remedial surgery was performed on the opposite bl-east to achieve symmetry. Complications occurred in two patien ts at the latissimus dorsi donor site (seroma in one patient, and seroma an d infection in one). Five patients underwent complete nipple reconstruction s. The mean duration of follow-up was 33.6 months (range, 15.5 to 70.3 mont hs), 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 patient s with prior breast augmentation, with good to excellent cosmetic results. Depending on the tumor and implant location, the implant may be preserved w ithout compromising local control.