Implications for clinical management in patients with breast cancer: long-term effects of reconstruction surgery

Article Abstract:

Breast reconstruction is being chosen more and more often by women undergoing surgery for breast cancer. Many women indicate that the reconstruction makes them feel better and more sexually attractive. Like any procedure, breast reconstruction has it's difficulties and possible complications. Patients who receive breast implants often develop capsular contractions, which are often painful. The condition may necessitate a replacement of the implant. Breast implant patients may also develop shoulder difficulties, although proper physical therapy should prevent this. The skin of the reconstructed breast invariably loses some sensation. If skin and muscle flaps are transplanted from another part of the patient's body, there is some sacrifice of sensation in both spots. There has been some concern that silicone materials used in the construction of some breast implants may contribute to the development of connective tissue diseases, including systemic sclerosis. However, such cases are rare, and there is little data yet to indicate that these are more than coincidental findings. No evidence has substantiated early fears that breast implants might lead to the development of cancer. Furthermore, while mammographic screening for cancer recurrence in reconstructed breasts may be more difficult, there is no evidence that indicates that this is of any clinical consequence. Physical examination of the breast is effective in detecting recurrences in patients with reconstruction. Breast reconstruction does not interfere significantly with any aspect of breast cancer treatment or patient follow-up. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Follow-up of breast cancer reconstruction cases

Article Abstract:

There is no doubt that the early diagnosis of breast cancer results in increased survival. Many women who have undergone mastectomy have chosen breast reconstruction, often involving the implantation of silicone material. These women remain at especially high risk because the early detection of a recurrent cancer may be more difficult among these women. There is concern that surgical scar tissue and foreign silicone material may obscure the appearance of a small recurrent tumor upon mammographic examination. Some suggest that for women who have had breast reconstruction physical examination may be more important than mammography. It may be easier for the physician to feel a small developing lump than for a radiologist to discern a lesion on the mammogram of a reconstructed breast. Still other medical practitioners suggest that the problems associated with imaging a reconstructed breast may be a compelling reason to return to total mastectomy as the treatment of choice for breast cancer. The trend in recent years has been toward more conservative surgery for the purposes of better cosmetic results. However, as the skills of the plastic surgeons have improved, it has become possible to obtain satisfactory cosmetic results even when the entire breast has been removed. Some believe that removal of the entire breast provides the best protection against recurrence, and with no breast tissue remaining, the concerns about interference of plastic surgery with mammographic imaging are of less consequence. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Nonimaging aspects of follow-up in breast cancer reconstruction

Article Abstract:

Many women who undergo surgery for breast cancer subsequently undergo breast reconstruction for cosmetic purposes. There is concern that breast reconstruction surgery may make it more difficult to detect new breast cancer or breast cancer recurrences in these women. Some discussions of this problem have focussed on imaging techniques such as mammography; the mammographic examination of a reconstructed breast may be less sensitive for small recurrent cancers. However, it should be pointed out that the majority of breast cancer relapses (85 to 95 percent) are detected clinically, not by laboratory tests or by mammography. The detection of recurrent disease in the breast often responds well to treatment. Similarly, the increased surveillance given breast cancer patients sometimes results in the early identification of new breast cancer in the other breast. When the recurrence develops in the chest wall, however, early detection may be of value for only a minority of patients. Chest wall recurrence is not, in the strictest sense, a local recurrence; in many cases, it is merely the first indicator of metastatic disease. Women who develop chest wall recurrences are likely to develop symptoms of other metastatic tumors scattered around their bodies. University studies of women with breast reconstruction have failed to identify actual incidents in which breast reconstruction masked the diagnosis of a breast cancer recurrence. (Consumer Summary produced by Reliance Medical Information, Inc.)

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