Breast cancer after mammary augmentation

Augmentation mammoplasty has been said to reduce the risk for subsequent development of mammary gland carcinoma, but it may confer a worse prognosis should breast cancer develop. Nine patients who had breast cancer after augmentation mammoplasty were treated at the Ochsner Foundation Hospital and Clinic. The mean interval between augmentation and the development of a palpable mass was 6.8 years (range, 2 to 20 years). Four patients were treated with modified radical mastectomy, one was treated with radical mastectomy, and four were treated with tylectomy, axillary dissection, and radiotherapy. One of the four treated with tylectomy required salvage mastectomy. Reconstructions were done in all except one mastectomy patient. Five patients had stage I disease and four had stage II disease at the time of diagnosis. Over a mean follow-up of 4.75 years from the time of diagnosis of carcinoma of the breast, three of the four patients with stage II disease have either had recurrent disease or died of breast cancer, and one of the patients with stage I disease died with hepatic metastases. Mammography was not found to be useful for the detection of masses after augmentation mammoplasty. Needle aspirations were useful for diagnosis of nodal disease outside the breast, but not helpful in diagnosis of the breast lesion proper. Our analysis suggests that breast augmentation and the patient's psychologic considerations may delay the diagnosis of breast cancer. Additionally, patients may fare worse when breast cancer develops after mammary augmentation. We recommend preoperative mammography in most patients before mammary augmentation, particularly in those over the age of 30 years and those with a family history of breast cancer.