Skip to main content

Breast cancer risk and surgical intervention

Plastic surgeons offer high risk patients a myriad of choices

February 27, 2008
American Society for Aesthetic Plastic Surgery (ASAPS)

An article appearing in the January/February issue of the Aesthetic Surgery Journal suggests that assessment of breast cancer risk prior to elective breast surgery can ultimately improve results for patients. The piece offers guidelines for plastic surgeons to help women gauge their breast cancer risk, and offer the best options for surgical intervention and reconstruction.

Estimates predict one out of every eight women will develop breast cancer at some point in her lifetime. The presence of breast cancer can be detected using MRI and mammography, however several other methods examine family history to gauge a woman's risk of developing the disease in the future. For women who are currently cancer-free, genetic testing can help identify how likely they are to develop the disease.

"Genetic testing, such as that for BRCA1 and BRCA2 (genes associated with breast cancer), has allowed clinicians to better tailor risk management strategies in patients from families with hereditary breast cancer," said Hooman Soltanian, M.D., lead author of the piece. "Plastic surgeons are in a unique position to provide early preventative options to their patients."

Surgical options for high-risk patients

Early intervention with particularly high risk women can mean they can choose from more surgical and reconstructive procedures. Many high risk women with no current signs of breast cancer, for example, are excellent candidates for types of prophylactic surgery such as skin sparing mastectomy or nipple sparing mastectomy."

The risk of developing breast cancer can be cut by 90% in high risk women through bilateral prophylactic mastectomy. Reconstruction procedures performed simultaneously can also provide excellent cosmetic results for the patient.

Some key considerations for patients at high risk for breast cancer include:

  • BRCA1 and BRCA2 related breast cancers generally occur in younger women, making detection by mammography difficult because of the denser breasts.
  • The current screening recommendations for patients who test positive for BRCA1 and BRCA2 mutations include monthly self breast exams starting at age 18, semiannual clinical breast exams starting at age 25, and annual mammography and breast MRI starting at age 30.
  • All breast reconstruction methods are available to patients with genetic predisposition for developing breast cancer; however, every high-risk patient must be counseled carefully and thoroughly to enable her to arrive at a decision suitable for her.
  • For patients with BRCA mutation, it is important to note that bilateral reconstructions can be very lengthy and a staged approach may be advisable, and must be coordinated with the oncologic and gynecologic surgeons during combined procedures.

"Close cooperation between oncologists and plastic surgeons will improve patients' psychosocial outcomes and decrease the psychological burden for patients who have been diagnosed with a genetic predisposition for breast cancer," added Dr. Soltanian.

Elective breast surgery and risk assessment

Even for women simply seeking aesthetic breast surgery, breast cancer risk assessment is important in determining the best course of action and, ultimately, optimizing results.

Guidelines for these patients include:

  • Prior to every elective breast surgery, special attention should be paid to any family history of breast or ovarian cancer.
  • Patients who are at high risk for breast cancer based on their personal and family history should be referred for further evaluation by a medical oncologist and/or geneticist.
  • Every woman 40 years of age and older should have a mammogram prior to an elective breast procedure. Some even recommend a preoperative mammogram in all women undergoing cosmetic breast surgery.
  • It is important to note that breast augmentation, reduction, mastopexy (breast lift) and implants may have significant consequences in screening and surveillance of breast cancer, specifically with regard to future mammographic evaluation. A new mammogram should be obtained three-to-six months after surgery, to serve as the new baseline for evaluation.
  • Ultrasound studies and MRI may be used to further evaluate patients with difficult or unsatisfactory mammograms.

"Plastic surgeons must play a part in monitoring women who come in for cosmetic breast procedures. These patients should be assessed for potential breast cancer risk by a physical examination as well as a family history evaluation," said Foad Nahai, M.D., President of ASAPS and Associate Editor of ASJ. "It is imperative that these patients understand their potential risk, if any, as well as the implications breast surgery may have on future screening, in order for them to make the best possible decision regarding their own care."