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

Summary

In the largest series worldwide, breast-conserving surgery after augmentation had re-excision rates comparable to national standards, with most patients retaining or exchanging implants and receiving radiotherapy. Mastectomy with immediate reconstruction showed acceptable complication rates, informing surgical decision-making in this growing cohort.

Key Findings

• Among 200 affected breasts, 71.5% underwent BCS; 18.9% required re-excision and 2.1% had completion mastectomy.
• T2 tumors had higher re-excision rates than T1 or T3 (p=0.003).
• In BCS cases, 87.4% retained or exchanged implants and 91.6% were recommended radiotherapy.
• 28.5% underwent mastectomy; 68.4% received immediate reconstruction; 5 patients reoperated within 90 days (2 implant losses).

Clinical Implications

Breast-conserving surgery is feasible with acceptable re-excision rates; implant retention/exchange and planned radiotherapy are common. Immediate reconstruction after mastectomy is reasonable with low short-term complication rates.

Limitations

• Retrospective design with potential selection and information biases.
• Heterogeneity in imaging, surgical techniques, and adjuvant protocols across centres.

Future Directions

Prospective registries with standardized imaging and surgical protocols; evaluate long-term oncologic and reconstructive outcomes including capsular contracture and radiation effects.