Can Breast Implants Hinder Breast Cancer Survival?

“Although cosmetic breast implants are popular, these devices still raise some concerns because they are radiopaque at mammography, which can impair the visualization of breast tissue.”

Cosmetic breast augmentation is the most commonly performed cosmetic procedure in the USA [101]. Although cosmetic breast implants are popular, these devices still raise some concerns because they are radiopaque at mammography, which can impair the visualization of breast tissue [1]. Consequently, the ability to detect breast cancer at an early stage may be affected by the presence of breast implants, which may subsequently affect breast cancer survival. One in eight US women will be diagnosed as having breast cancer at some time in their lives [2]. Thus, it is reasonable to say that a number of women with cosmetic breast implants will go on to develop breast cancer. Therefore, it is important that women considering breast augmentation surgery, and those who already have cosmetic breast implants, are informed of the issues related to the diagnosis and prognosis of breast cancer when using these devices.

Breast implants have been used since the early 1960s [3]. Also known as augmentation mammaplasty, breast implant surgery is an elective surgical procedure to enhance the size of a woman's breast by insertion of a mammary prosthesis behind each breast [4]. They are mainly used for cosmetic purposes, but also for breast reconstruction in the case of a mastectomy. There are mainly two types of cosmetic breast implants; silicone gel-filled implants and saline-filled implants. Silicone gel-filled implants are made of a silicone elastomer shell of varying thickness that encases different volumes of silicone gel and oil. Saline-filled implants consist of a single lumen enclosed by a silicone elastomer envelope. These implants are inflated with sterile saline via a self-sealing valve through a closed system into the recipient [4].

Since their first use over half a century ago, cosmetic breast implants have been subject to a number of controversies. For instance, concerns over silicone as a potential carcinogen were raised in the 1980s [5]. Nevertheless, several studies investigated long-term cancer risk among women with cosmetic breast implants and found no association with breast cancer risk [6,7]. However, the issues of breast cancer detection and breast cancer survival when using these devices have been studied less.

The amount of parenchymal breast tissue obscured at mammography by the implant is known to be between 22 and 83% [8]. This can be explained by several mechanisms. For instance, the visualization of breast tissue can be impaired by an insufficient compression of the breast in the presence of breast implants. Implant-related artifacts can also be observed on the imagery which can increase the difficulty in interpreting mammograms among women with breast implants [1,9]. In fact, the presence of breast implants increases the false-negative rate (poorer sensitivity) of mammograms compared with nonaugmented breasts, but does not increase the false-positive rate (poorer specificity) [10]. Specialized radiographic techniques have been developed for women with breast implants to improve visualization of the breast tissue. This is done by bringing breast tissue over and in front of the implant and by pushing the implant against the chest wall [11,12]. Even when using these specialized techniques, a third of the breast tissue cannot be properly visualized [1]. It has also been shown that capsular contracture, a scar tissue that develops in response to the foreign object around breast tissue, which is seen in approximately 15–20 % of augmented women can reduce mammographic sensitivity by 30–50% [4].

A recent systematic review and meta-analysis conducted by our group showed a tendency towards later stage of breast cancer at diagnosis among women with cosmetic breast implants [13]. Moreover, breast cancer-related survival following the diagnosis of such disease was also investigated given that the possible diagnosis of advanced tumors could translate into poorer survival. We found that cosmetic breast implants seem to adversely affect breast cancer-specific survival following the diagnosis of such disease [13]. These findings of later breast cancer stage at diagnosis and lower breast cancer survival are important; women with breast implants or considering having implants need to be informed of such findings. Moreover, recommendations regarding breast imaging in the presence of breast implants need to take these findings into account.

Furthermore, it has been suggested that specific breast implant characteristics might affect the detection of breast cancer to variable extents [14]. For instance, subglandular implant placement (i.e., implants placed under the breast glands) could obstruct the visualization of mammograms more than submuscular placement owing to its proximity with breast tissue [14,15]. In fact, previous reports showed that subglandular placement may obscure 39–49% of breast tissue compared with 9–28% for submuscular implant placement [14,15]. However, to date, the issues regarding the stage of breast cancer at diagnosis and breast cancer survival have not been separately clarified for these two types of implant placement. Further studies need to be conducted to clarify these issues as they could affect recommendations to women and their physicians.

As the female population with breast implants increases and ages, the number of breast cancer cases diagnosed in this population will increase, and clinical concerns about the detection of these breast cancers and subsequent survival need to be addressed. Many women around the world have cosmetic breast implants and given their increasing popularity, more women are expected to have breast augmentation for cosmetic purposes. Therefore, women considering such procedures, women who already have implants and physicians and other health professionals who treat these women, should be informed of the issues regarding breast cancer diagnosis and prognosis in the presence of breast implants. Women with breast implants or considering having implants should discuss these important issues with their healthcare professionals.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.