Breast Cancer After Breast Augmentation study (BCABA): A national multicentre collaborative study of patient management and outcomes.

[BACKGROUND] The incidence of breast cancer diagnosis in patients with previous cosmetic breast augmentation is increasing, and poses challenges in management. Given the uncertainty in how to manage these patients, we aimed to evaluate current UK practice in this patient group, encompassing both breast conserving surgery (BCS) and mastectomy with or without reconstruction.

[METHODS] Women diagnosed with invasive or in-situ breast cancer from January 2012 to January 2024 with pre-existing implant augmentation were identified and demographic, pathological, and operative data was recorded. Outcomes included imaging findings, surgical approach, complications, and adjuvant treatments.

[RESULTS] 196 women with 200 breasts with cancer were identified. There were 168 (84.0 %) patients who presented symptomatically and 28 (14.0 %) via the NHS breast screening programme. 143 (71.5 %) breasts underwent BCS of which 27 (18.9 %) required further margin re-excision and 3 (2.1 %) had completion mastectomy. Patients with T2 tumours had higher rates of margin re-excision compared to patients with T1 and T3 tumours [p = 0.003]. Within the BCS group, 125 (87.4 %) retained or exchanged an implant and 91.6 % of these patients were recommended for radiotherapy. 57 (28.5 %) breasts underwent mastectomy including 39 (68.4 %) that were reconstructed. Of the entire cohort, 5 patients returned to theatre within 90 days for a complication, including 2 implant losses.

[CONCLUSION] This is the largest reported series of these patients worldwide. There are wide variations in surgical management. Overall re-excision rates following BCS in patients with previous augmentation are comparable to national standards. Mastectomy with immediate reconstruction has an acceptable rate of complications.