Five Year Results of Radiation Therapy in Patients with Previous Breast Silicone Implants

Abstract

To evaluate results of local control and aesthetic outcome in cosmetically augmented breast cancer patients. We retrospectively reviewed the records of 40 patients with Stage I and II invasive carcinoma of the breast who underwent breast conserving surgery and radiation therapy (RT) between 2000 and 2006. All patients were treated with lumpectomy, sentinel lymph node biopsy and/or axillary dissection followed by RT. All patients had previously placed silicone implants. Each patient's cosmetic outcome was scored by Baker classification grading system (grade 1 to 4) prior and post radiotherapy. Each patient was treated with 3D planning. Median dose to the whole breast was 50 Gy and 16 Gy for the boost. Chi-squared test and univariate and multivariate Cox regression analyses were also performed. The median follow up for all patients was 60 months and the median age was 46 years (range 35 - 60). Thirty four patients (75%) had a favorable cosmetic outcome (Baker grades 1 - 2) following breast conserving therapy. Six patients (15%) had an unfavorable cosmetic outcome (Baker grades 3 - 4). Only one patient had her implants exchanged. On univariate analysis when comparing Baker grades 1 - 2 vs. Baker grades 3 - 4 categories, no significant correlation was found between the degree of contracture. (p = 0,981). Multivariate analysis didn't show correlation with other variables such us chemotherapy, hormone therapy and smoking (p = 0,604). There were two local failures (T2 size and closer margins) and two patients had distant metastasis without local relapse. At five years follow up, the majority of patients had excellent cosmetic results with minimal late skin changes or contracture. We concluded that with proper radiotherapeutic techniques good cosmetic and local control rates can be obtained in these patients without compromising their therapy. Therefore, previous breast implants should not be a contraindication to breast conserving therapy among these patients.