Breast Augmentation for Irradiated Patients

Friday, April 12, 2013
Yoshiko Iwahira, MD, Breast Surgery Clinic, Tokyo, Japan
Goals/Purpose: Breast augmentation is very common surgery all over the world. However,if the patients who desire this surgery had radiation therapy done at her breast before,the complication risk would become bigger. Breast conserving therapy (BCT) has enormously increased as a standard operation for breast cancer.  The most important purpose of BCT is not only local control, but also good aesthetic results after surgery. However, though an insignificant different result has been shown between BCT and mastectomy, achieving aesthetic results is sometimes difficult. The objective of this study is utility of augmentation with soft cohesive silicone implant  for irradiated patients.

Methods/Technique: Between April 2003 to December 2009, 56 patients were treated by one surgeon for augmentation mammoplasty with irradiated patients. The mean age was 45 years (range 23-52years). Five patients had been treated on bilateral breasts. 42 cases had been treated irradiation after lumpectomy. All patients were classified into two groups, Type I and II by Clough. Breast augmentations were performed with the soft cohesive implant from infra-mammary fold under the pectralis major muscle. 48 patients were used different size implants at each breast. Three patients wanted vertical mastopexy, augmentation mastopexy at the same time. Medial follow-up after reconstruction was 32 months (range, 24 -70 months).

Results/Complications: All patients had satisfactory postoperative results. The position of N-A was transferred towards lateral upper direction in five patients. More than capsule contracture III was seen in two patients.

Conclusion: The indication for conservative treatment of breast cancer is expanding. The difficulty in reconstruction for these BCT deformities is their variety and irradiation after surgery. The complication after radiation is well-known risk of reconstruction. Delayed healing, persistent postoperative edema, and extensive fibrosis are due to the mobilization of insufficiently vascularized tissues. This technique is not bother clinical examination of recurrence like ultrasound, MRI, mammography or fine-needle biopsy of any suspicious zone. The purpose of breastaugmentation has to be a simple approach to sub-muscularlocation, inconspicuous scar,minimal complication even though irradiated, and high degree of patient satisfaction.