Although man of the health and safety issues associated with breast augment
ation have been thoroughly discussed over the past decade. the literature i
s remarkably silent regarding postmastectomy reconstruction of tile prevous
ly augmented breast. A retrospective review of the senior author's reconstr
uctive practice was performed for the years 1983 through R larch of 1999, r
evealing 21 women who underwent postmastectomy breast reconstruction after
previous breast augmentation. For purposes of measuring aesthetic results,
these 21 patients were matched to a carefully selected control group of 15
patients. They were also compared with other, larger populations, including
777 of the senior author's other breast reconstructions, the breast cancer
registry at the Lombardi Cancer Center in Washington, D.C., and several la
rge, published epidemiologic studies.
The interval between the previous augmentation and the diagnosis of br east
cancer ranged from 9 months to 18 years, with a mean of 9.3 years. None of
the previous augmentation implants was ruptured at the time of mastectomy.
Of the nine patients with previous subpectoral augmentation, cancer was de
tected mammographically in five (56 percent), whereas of the 12 patients wi
th previous subglandular augmentation, cancer was fir st detected mammograp
hically in only three (25 percent). This difference was not statistically s
ignificant (P = 0.2). Overall, eight of the study patients' tumors (38 perc
ent) were first detected mammographically, which is similar to other publis
hed reports of breast cancel patients in the general population. Seventy-on
e percent of the 21 study patients were node-negative, which also compares
favorably with other published series.
Sixteen of the women with previous augmentation (76 percent) had purely pro
sthetic reconstructions, Flaps were used in the other-five reconstructions
(23 percent): three latissimus dorsi flaps (14 percent) and two transverse
rectus abdominis musculocutaneous flaps (9 percent). All five flaps were us
ed in patients who had undergone radiation therapy. Throughout tile senior
author's entire reconstructive practice history transverse rectus abdominis
musculocutaneous flaps were more frequently used [282 of 777 nonaugmented
reconstructions (36 percent)], whereas latissimus dorsi flaps were less fre
quently used [17 of 777 nonaugmented reconstructions (2.2 percent)] (p < 0.
The cosmetic results of the breast reconstructions in the previously augmen
ted study group were generally good-re-excellent, with a mean score by blin
ded observers of 3.35 of a possible 4.0. These results were comparable to o
r better than those in the matched controls, who scored a mean of 9.0.