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


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).


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.


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.


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.