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

PURPOSE:

Cosmetic outcomes and rate of implant loss are poorly characterized among breast cancer patients 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 radiotherapy (WBRT).

METHODS AND MATERIALS:

Breast cancer patients with a prior history of breast augmentation presenting to our institution from January 2006 to January 2017 who elected BCT were included. 71 breast cancers in 70 patients with a history of BA electing BCT were retrospectively identified. Clinicopathologic, treatment, and outcome variables were examined. WBRT included conventional and hypofractionated schedules with and without a boost. Rates of implant loss as well as cosmetic outcomes among patients who did and did not develop a new/worse contracture based on physician assessment were compared.

RESULTS:

54.9% of patients received radiation using hypofractionated whole-breast tangents; 81.7% received a boost. 18/71 cases (25.4%) developed a new/worse contracture after BCT with a mean follow-up of 1.9 years. 9/71 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, radiation therapy (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 following 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.