APBI Using Brachytherapy in the Presence of Breast Augmentation: 320 Women

Abstract

Breast augmentation has been one of the most common surgical procedures in the US for the past 20 years with an average of 320,000 cases per year. Many of these women are being diagnosed with breast cancer as they age. The reported rate of capsular contracture with whole breast irradiation is 55%, resulting in many mastectomies for early-stage disease. Brachytherapy has the advantage of limited radiation exposure to the implant. We report mature data on 320 women treated between 2001 and 2021.This retrospective review includes patients from 2 institutions with 71 months mean follow-up. 64% had saline and 36% silicone implants, with 83% subpectoral and 17% prepectoral. Median age is 54 years (22-82). 269 interstitial (median 17 catheters), 43 SAVI, 8 balloons. Stage Tis = 26%, T1N0 = 52%, T2N0 = 8%, N1 = 14%. Surgical margins negative 85%, close 14%, and positive 0.6%.The mean PTV = 74cc, DHI for interstitial and single entry is 7(% and 58%, and median V90 = 96%. Ten had IBTR (3.1%), 4 TRMM and 6 elsewhere. 3 had nodal recurrence only. Cosmesis at 2 and 5 years: Excellent/Good 100%, 97.5% Mod-severe fibrosis 5%. Capsular contracture 4% before treatment and 3.4% after brachytherapy.Brachytherapy APBI in the presence of breast augmentation offers excellent tumor control with markedly reduced rates of capsular contracture or complications.