Friday, September 23, 2011

The Latest Research on Breast Reconstruction after Mastectomy

Today we'll share the latest news and research on breast reconstruction after mastectomy. Topics include the reconstruction decision, the safety of silicone and a study on two-stage implants. Links to the news items and studies below may be found on the breast implant (with expander, two-stage) page of our website.

The decision to pursue reconstruction

Women facing breast cancer have many decisions to make about treatment. If a mastectomy is selected, additional decisions about breast reconstruction are required.

Reconstruction is not for everyone. According to a September 23 article in The Atlantic, women consider many factors such as cost, convenience and lifestyle. For women who decide against reconstruction, a variety of removable prosthetic breasts are available.

For those who choose reconstruction, there are many options, including saline and silicone implants and tissue grafting procedures such as TRAM flap, DIEP free flap and Gluteal free flap procedures.

Unfortunately, not everyone may be aware of their options. The Atlantic story noted that "the data suggest that only three in seven women get the chance to learn about reconstruction before they begin cancer treatment."

Moreover, uninsured women may never be informed of their reconstruction options. In a recent study, 52% of the 54 uninsured women "knew nothing about breast reconstruction." After learning about their options, the percentage who chose reconstruction rose from 47 to 76 percent (link).

FDA update on the safety of silicone implants

For those who choose silicone breast implants, there have been some concerns about safety. Back in June, the FDA issued an Update on the Safety of Silicone Gel-Filled Breast Implants. It was big news at the time, with the Los Angeles Times, The Washington Post, MedPage Today and Medical News Today covering the story.

Essentially, the FDA reviewed the latest studies and concluded that "silicone gel-filled breast implants have a reasonable assurance of safety and effectiveness when used as labeled." It found "no apparent association" between the implants and breast cancer, connective tissue disease or infertility.
Importantly, the FDA noted that 40 to 70 percent of breast reconstruction patients will need an additional surgery to modify, remove or replace the implant within the first 8 to 10 years. It recommended lifetime monitoring with periodic MRIs to detect asymptomatic ruptures.

The latest study on two-stage breast reconstruction

Breast implant reconstruction may be implemented in one or two stages. With one-stage, the implants are inserted immediately after the mastectomy. With two-stage, tissue expanders are inserted after the mastectomy, and replaced with permanent implant sometime later.

The latest study on two-stage breast reconstruction was published online in the American Cancer Society journal Cancer on September 14.

The study followed 151 women with stage II or III breast cancer for about 7 years. All received a skin-sparing mastectomy and axillary lymph node dissection with the placement of a tissue expander. All were treated with chemotherapy. About 4 weeks after chemo, tissue expanders were replaced with saline or silicone permanent implants. 8 weeks after the completion of chemo, post-mastectomy radiation was initiated.

At 7 years, local and regional control was 100%. Two women experienced chest-wall recurrence, but after 7 years. 29 patients experienced a distant metastasis. The 7-year distant metastasis-free survival rate was 81% and overall survival rate was 93%.

At 7 years, 29% underwent permanent implant removal or replacement (17.1% removal and 13.3% replacement.) The authors noted that it is "important" to consider this rate in the "context of the longevity of implants." They note,
"Breast prostheses are not permanent devices and may require revision over the life course of patients, even in women who receive implants primarily for augmentation purposes."
The study was unable to identify any factors, including implant type, which predicted a risk of implant replacement or removal.

The authors noted several limitations to their study. First, surgeries to modify the implants due to complications were not considered, but could be important as they they can "impact cost and quality of life." Also, the women in the study were treated at a single cancer center, Memorial Sloan-Kettering. The results "may not be generalizable to other populations at large."

At, we'll continue to follow the research in the field of breast reconstruction. Developments will be added to our website and database and highlighted here. Please stay tuned.

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