Breast cancer in women with implants: diagnosis and treatment

With breast augmentation sitting as the number one cosmetic surgery in the U.S. and breast cancer affecting as many as one in 8 women, the numbers of women with implants who develop cancer can be expected to increase dramatically in coming years. It is important to point out up front that studies have found no link between breast implants and breast cancer; what we are talking about here is what is expected by coincidence. Rather, the important considerations relate to diagnosis and treatment.
The most important question regarding cancer diagnosis and implants is whether the implants obscure part of the breast during screening mammograms or self exam. If so, one would expect small cancers to be missed so that they are not found until they have grown to a more advanced stage. The good news here is that this doesn’t appear to be the case, according to several studies. Some special mammogram views may be required but most centers know what to do. And don’t worry about damaging the implants with a mammogram.
If a cancer is found, what next? The most common approach to early breast cancer is what is called lumpectomy –removal of the area containing the tumor – and then radiation treatment. This is called “breast-conserving” treatment, though it can affect the appearance of the breast substantially. When implants are present, there is a very high probability that the radiation will cause a scar contracture (capsular contracture) which will make the breast hard and misshapen. So for women with implants this is not usually a good option unless the implants are removed. A better choice may be to do a skin and nipple-sparing mastectomy and immediate reconstruction. This would be done using a larger implant so that the final size replaces the volume of the breast tissue that was removed as well as the implant. That would further have the advantage of avoiding the need for radiation, and could be done in one stage if an acellular matrix such as Alloderm is used to make an internal bra.
In a nutshell then, I do not recommend radiation treatment for women with implants. If you unfortunately find yourself in the position of dealing with breast cancer after breast augmentation, talk to your plastic surgeon before deciding on treatment.