The breast has always been considered a powerful symbol of femininity and beauty. This perception, rooted in culture and history, leads many women to consider the shape and size of their breasts as an important aspect of their female identity. The choice to undergo operations such as breast augmentation often reflects the desire to strengthen this expression of femininity. This is the most practiced plastic surgery procedure in Italy. Since breast cancer affects 1 in 8 women in their lifetime, the number of breast augmentation patients facing a breast cancer diagnosis is unfortunately not insignificant. How do we intervene in these patients? Having already undergone breast augmentation surgery, what should you do if you are diagnosed with breast cancer?
A safe surgery
According to data relating to 2022 from the International Society of Aesthetic Plastic Surgery (Isaps), there were 2.2 million breast augmentation operations in the world. Italy is eighth in the world ranking for the number of cosmetic surgery and medicine procedures, with 262,556 cosmetic surgery operations and among these 42,000 breast augmentation operations. “Breast enlargement surgery is now consolidated and safe,” he added Riccardo Masettidirector of the Senology Center of the Irccs Foundation Policlinico Universitario Agostino Gemelli and founder of Komen Italia who adds: “For many women who have a bad relationship with their breasts, mammoplasty goes far beyond the aesthetic result, helping them to find a better psychological balance and a greater degree of satisfaction.”
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More accuracy in diagnosis
Once breast augmentation surgery has been performed, are there any special precautions to take? “You need to be aware of the fact that breast implants make it a little more difficult to interpret images for the purposes of early diagnosis of a tumor,” replies Masetti. “I would like to point out that there is no reason to be alarmed, only that it is particularly important for women who have undergone breast augmentation to carry out preventive examinations at specialized breast diagnostic centres”. In practice, greater expertise is required for the correct interpretation of mammographic images in women with breast implants. “In these women – adds Masetti – it is particularly important to make use of magnetic resonance imaging to be integrated with mammography and ultrasound in case anomalies emerge because, in addition to being helpful in the early diagnosis of the tumor, it is also the most sophisticated examination for evaluating the state of integrity of the prostheses over time”.
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Don’t wait for screening
Generally, women who choose to have breast augmentation surgery are quite young (the age is decreasing year by year) between 30 and 40 years old: it is useful to carry out checks already at this age even if the Lines guide predict them starting from the age of 50? “The rules – replies Masetti – are the same for everyone but in reality we also suggest that young women who do not have prostheses from the age of twenty onwards have ultrasound checks at least once every two years and then start having mammography around the age of forty once a year regardless of the national screening which starts from the age of fifty”.
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How to intervene surgically
In the event of a diagnosis of breast cancer requiring surgery, some assessments must be made in order to then make a shared decision on how to proceed: “Generally, women who undergo breast augmentation surgery do so because they have small breasts. In the case of surgery to remove the tumor – explains Masetti – you can opt for two choices: remove what remains of your breast and simply replace the prosthesis that already exists with a slightly larger one that replaces the part of the breast original which is removed at the time of the operation and thus has a fairly homogeneous volume compared to the other breast”.
The other option is to leave the breast by removing only the part affected by the tumor: “As happens in 80% of cases in which the tumor is diagnosed in the initial phase – explains the surgeon – an operation is performed in which the only the lesion is done with a quadrantectomy or a lumpectomy, i.e. the surgical removal of a discrete portion of breast tissue leaving part of the original breast. In this case, the aesthetic result of the reconstruction is better and more natural.”
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There is no need to wait
Another open question for women with breast implants is the timing with which it is possible to intervene. Good news for these patients comes from a recent study conducted in Italy on 38 patients and published in the journal Aesthetic Surgery Journal thanks to which it is possible to dispel the fake news according to which in patients with breast prostheses inserted for aesthetic purposes prior to the diagnosis of cancer, it is not possible to carry out immediate reconstruction with the definitive prosthesis at the same time as the demolition phase of the mastectomy. “Patients undergoing breast augmentation surgery who face a diagnosis of breast cancer can undergo immediate reconstruction with a definitive prosthesis positioned preferably in front of the pectoral muscle,” he explains Marzia Salgarelloreconstructive plastic surgeon at the Agostino Gemelli Irccs University Polyclinic Foundation, President Beautiful After Breast Cancer (BABC) Italia Onlus and first signatory of the study. If they are very thin, the prosthesis is placed behind the pectoralis major muscle. “The study – adds Salgarello – demonstrated that immediate reconstruction with the definitive prosthesis is possible with a satisfactory aesthetic result. In particular, if the prosthesis is positioned in front of the muscle the result is natural, recovery is simpler and quicker, with an excellent quality of life for the patient.”
A question of position
In short, in patients who have already had breast augmentation before the tumor, an evaluation must also be made regarding the position of the prosthesis. “Traditional breast reconstruction with a definitive submuscular implant is often considered the standard approach, regardless of the previous position of the implant. However – he explains Liliana Barone Adesi, medical director of the Plastic Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli Irccs, Vice President Babc Italia Onlus and signatory of the study – the recent trend to do a prepectoral reconstruction provides an innovative solution even in the majority of patients with previous prostheses. Our analysis revealed that immediate prepectoral reconstruction represents a feasible option for patients with a history of breast augmentation. Decisions regarding the reconstructive approach are influenced by variables such as the thickness of the mastectomy flap, the status of the previous prosthesis and the condition of the periprosthetic capsule. But in each of these cases immediate reconstruction is possible.”
To each his own choice
For women who have undergone breast surgery with conservative surgery, the treatment protocols then include radiotherapy to optimize what is called local control of the disease. “We now know that, in terms of risk for the patient, complete removal of the breast or partial removal followed by radiotherapy have the same guarantees and this also applies to women who have prostheses but different considerations must be made” . For those who choose, in agreement with the oncologist, to also remove the small residual part of their breast on which the breast prosthesis was grafted, the reconstruction will be simpler: “In fact, the prosthesis is already there and you just need to replace it with a larger one but aesthetically the result is less satisfying because the natural coverage given by the original breast is missing. On the other hand, however, there is the advantage that he will not have to undergo radiotherapy”, explains Masetti.
Radiotherapy and prosthetics don’t mix
If, however, you choose to do a conservative operation, in cases where it is possible, then the woman will have to undergo radiotherapy: “The aesthetic result of the operation is almost always better, but the problem is the radiotherapy which is not suitable for I agree with prostheses because they cause changes in the skin, hardening, swelling and pain which are sometimes quite annoying. This is why the choice of what to do or not to do for women with breast implants who discover they have breast cancer must be somewhat personalized on a case-by-case basis, based on other parameters such as age, the biological characteristics of the tumor, its size and that of the original breast, any familiarity and the risk that it may recur”.