June #PRSJournalClub Wrap-Up: Breast Cancer After Augmentation

by Erez Dayan, MD (@ErezDayanMD)

The June edition of #PRSJournalClub included lively and thought provoking discussion of the article entitled ‘Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy’ by authors from Duke and University of Pennsylvania- Eugenia H Cho, B.S.; Ronnie L. Shammas, B.S.; Brett T. Phillips, M.D., MBA; Rachel Greenup, M.D., M.P.H; Shelley E. Hwang, M.D., M.P.H; and Scott T. Hollenbeck, M.D.

This retrospective study assessed the impact of prior breast augmentation on the diagnosis and management of breast cancer in women undergoing mastectomy. The importance of this study is underscored by the high prevalence of breast cancer (one in eight women) combined with the common practice of breast augmentation (300,000/yr in the United States). These incidence rates predict that each year approximately 35,000 women who had breast augmentation will be diagnosed and treated for breast cancer.

Cho et al. evaluated all women with a history of prior breast augmentation who underwent therapeutic mastectomy at Duke from 1993-2014 (n=89) and compared them to all women without prior augmentation undergoing mastectomy in 2010 (n=171). Subanalysis was performed according to implant placement- subpectoral (n=63) vs subglandular (n=27). This study showed that breast cancer stage at diagnosis was similar regardless of patients having prior augmentation. Also, cancer detection method (self-exam vs mammography) was no different between the two groups. However, among women with augmentation, subglandular implants were associated with more advanced breast tumors (p=0.01) and were more commonly detected on self-palpation rather than mammography (p=0.03). Indicating that implant placement can make it harder to detect lumps with self-examinations. The authors concluded that although there is no evidence of delayed diagnosis of breast cancer after augmentation, women with subglandular augmentation should have increased vigilance in following breast cancer screening recommendations. The authors further suggest a potential benefit of subpectoral augmentation over subglandular in regard to mammographic screening effectiveness.

We congratulate the authors on what is the largest observational analysis to date of women undergoing mastectomy after breast augmentation.

This impactful article was discussed in multiple social media platforms for a worldwide audience, providing an in-depth discussion as well as an excellent twitter Journal club with the authors.

PRS Journal Editor-In-Chief Dr. Rohrich (@DrRodRohrich) outlines important points of this paper and discusses breast augmentation and cancer detection in a the following “Hot Topic” video (#PRSHotTopic):

Also, this month’s #PRSJournalClub topic was enhanced by an insightful podcast moderated by Debra Johnson, MD, current president of the American Society of Plastic Surgeons, and Resident Ambassadors to the PRS Editorial Board Jordan Frey, MD (@JordanFreyMD), Shuja Shafqat, MD (@shujashafqatmd), and Chad Purnell, MD (@ChadPurnellMD) on this month’s PRS Journal Club Podcast. Listen to their review here:

As always, a highlight of #PRSJournalClub was the live two day twitter discussion with the authors. On Sunday and Monday, June 25th and 26th, article authors Eugenia Cho (@ejinnycho), Brett Phillips (@mdbphillips) and Scott Hollenbeck (@sth_43206) engaged a worldwide audience, discussing numerous questions regarding their study and its significance on clinical practice. Plastic surgeons, residents, and students from all levels of expertise and practice backgrounds contributed to the discussion. This provided for a lively and thought provoking discussion. Don’t worry if you missed it! Highlights of the live twitter Journal club are provided below.

Enjoy the recap and please join us for our next #PRSJournalClub!

Thank you,
Erez Dayan, MD
Chief Resident
Harvard Plastic Surgery

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