Bilateral mastectomy reconstruction in the previously augmented patient.

TO THE EDITOR: I was delighted to read the article by Drs. Spear, Clemens, and Dayan on “Considerations of Previous Augmentation in Subsequent Breast Reconstruction” (Aesthetic Surg J 2008;28:285–293). This is a particularly timely and relevant article, because we have entered into an era in which a large number of women who have undergone breast augmentation have matured into the age group that has a high percentage of breast cancer. Plastic surgeons are increasingly treating those patients with breast cancer who have been previously augmented. The current article is a retrospective review of the senior author’s experience in 32 patients undergoing breast reconstruction subsequent to breast augmentation. They suggest that a higher percentage of breast cancer is detected mammographically in those with subpectoral augmentation versus subglandular placement, but this was not statically significant because of the insufficient population size. They also show that there is no delay in cancer detection. Both concepts have been previously demonstrated. Their experience with reconstruction appeared to use the standard spectrum of reconstructive techniques used in non-augmented patients. It is clear from the authors’ perspective that breast conservation therapy with or without radiation therapy yields a poorer aesthetic outcome. This is an opinion that I share. I have taken a more aggressive stance to breast reconstruction in the previously augmented patient.1 The lifetime rate of developing a contralateral breast cancer is around 15%, and this is similar to those patients with ducBilateral Mastectomy Reconstruction in the Previously Augmented Patient