Expert: Minas T Chrysopoulo, MD - 3/2/2008

Question
Hey Doc,
 I really would like to get breast augmentation but I am scared because my Mom has had breast cancer. I have even heard that some doctors won't do the surgery on women with with a close family relation of breast cancer. Is that true? I mean, what happens to a woman who has implants and gets breast cancer. Wouldn't it be the same procedure as if she did not? What are all the differences? And what would the breast look like after the removal of an implant due to cancer?
Thank you so much for your time helping me...Carol

Answer
Dear Carol,

You have raised a very important question. Certainly it highlights the importance of thorough patient education. You are right to have reservations about undergoing breast augmentation considering your close family history of breast cancer.

The truth of the matter is that breast implants can obscure some of your breast tissue on mammogram, particularly if the breast implants are placed above the muscle ("subglandular"). Studies have suggested that placing the implant under the muscle ("subpectoral") may allow more breast tissue to be seen on mammogram as the implants can literally be moved out of the way easier. Regardless of whether the implants are placed above or below the muscle you will still need to inform whoever is taking the mammogram that you have breast implants in place as additional pictures ("views") will need to be taken because of the implants. You must also take in to account however that mammograms are very technician dependent and even women without breast implants sometimes need repeat mammograms because some breast tissue was missed. If there is an issue on mammogram then the next step would be an MRI.

Multiple studies have been performed involving many centers and thousands of women. There is no scientific evidence that breast implants cause breast cancer. In fact, some studies have shown that there is a survival benefit associated with breast implants in augmented women subsequently diagnosed with breast cancer. We think this may be because often times the new mass is picked up sooner in augmented women because women with breast implants may be more vigilant about examining their breasts (all women should perform self examination once a month whether they've undergone breast augmentation or not).

As to whether plastic surgeons enhance women with similar situations to yourself.... I'm sure some do and some don't. My feeling is that plastic surgeons must take the time to ensure that every patient understands the implications that I've mentioned. As long as we educate our patients thoroughly, it must be up to the patient. It's a very personal choice without a right or wrong answer. What IS wrong is to operate on a patient without fully educating them first.

To answer your next question, if a woman with breast implants subsequently develops breast cancer she is treated in pretty much the same way as someone without implants - the cancer comes first. While there may be some subtle nuances depending on the patient's presentation and treatment plan (eg whether radiation is planned), the breast reconstructive options and procedures are essentially the same whether you've had previous breast augmentation or not. My breast reconstruction technique of choice uses the patients lower abdominal skin an fat (DIEP flap) to reconstruct the patient's breast following mastectomy so in my patient population the breast implant is usually removed with the rest of the breast at the time of mastectomy. In short, breast implants usually will not add to the number or complexity of procedures required.

At the end of the day it really is down to you. If you really want breast implants after what you've learned then go for it. There is no evidence to suggest you're increasing your risk but do some soul searching first. Plastic surgeons can throw statistics at you and tell you you're not increasing your risk until the cows come home but they're not the ones that will be laying in bed at night after the surgery wondering whether they've done the right thing or not, you are. Think about. There is no rush. Just make sure you are ok with your decision either way. If you choose to undergo breast augmentation then consider having the implants placed under muscle (probably easier to see breast tissue on mammogram), don't miss your scheduled mammograms and be vigilant with your breast exam (monthly).

Hope that helps.

Dr Chrysopoulo
PRMA Plastic Surgery, San Antonio, Texas
http://www.prma-enhance.com
http://breast-cancer-reconstruction.blogspot.com