Lumpectomy Plus Radiation Therapy Can Spare Breast Implants

A cosmetic breast implant does not need to be removed to treat women with early-stage breast cancer who are having a lumpectomy, a Mayo team reported here.

“The fact that a woman has a breast implant does not appear to impact outcomes if she wants breast conserving surgery,” Rosalyn Morrell, M.D., reported at the American Society for Therapeutic Radiology and Oncology meeting here.

She described 26 women with breast implants who were successfully treated for early breast cancer with lumpectomy plus radiation, without removal of the implant, between 1994 and 2004, at the Mayo Clinics in Scottsdale, Ariz., Jacksonville, Fla., and Rochester, Minn.

“We found that 22 of the women had good results, achieving a 1 or 2 on the Baker classification,” said Dr. Morrell, now at the Chandler (Ariz.) Regional Hospital. On the Baker scale, a score of 1 means the breast looks and feels normal after surgery. A score of 2 is also cosmetically acceptable. Scores of 3 or 4 are usually considered unacceptable.

The four women who scored 3 or 4 on the Baker scale had their original implant replaced, followed by cosmetic surgery to create a more normal looking breast, Dr. Morrell said in a poster presentation.

Most important, Dr. Morrell said, after an average of three years’ follow-up, all the women remain breast-cancer free.

As more women undergo breast augmentation surgery—about 300,000 in 2004—the odds are that more women will be candidates for lumpectomies with implants, Dr. Morrell said. Current statistics indicate that breast implants do not increase the likelihood of having breast cancer, she added. Her analysis of the cases indicated that age was the only significant risk for breast cancer in the women studied.

In past years when a woman with an implant would be diagnosed with breast cancer, doctors would routinely remove the implant as part of the surgical treatment, said Gregory Swanson, M.D., an associate professor of radiation oncology and urology at the University of Texas at San Antonio.

“Then we had a woman who said she didn’t want the implant removed and asked us to proceed without taking it out,” Dr. Swanson said. “We did, and she did well. We have now done a handful of women similarly without any problems.”

Dr. Swanson, who was not part of the Mayo study, said that overall his experience has been similar to Dr. Morrell’s. He suggested that for women with early-stage breast cancer who have implants, there should be no particular problem preserving the implants—depending upon the anatomy of the lesions.

“Past research, which showed only a 50% satisfactory cosmetic outcome, was based on a small sample of patients and older radiation techniques,” Dr. Morrell said. Advances in surgical and imaging techniques and radiation technology, she added, make it more feasible to perform breast conservation surgery with radiation—the standard of care for the procedure—without adversely affecting the feel of the implant in the breast.

Source: American Society for Therapeutic Radiology and Oncology 47th annual meeting

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