The question of whether cancer can develop in a reconstructed breast is common for anyone considering reconstructive surgery. Breast reconstruction, using implants or tissue flaps, restores the breast shape following a mastectomy. While a mastectomy removes the vast majority of breast tissue, it is impossible to eliminate every single cell. Cancer can still recur in the remaining native tissues, or patients with implants may develop a distinct, rare form of lymphoma.
Understanding Recurrence Risk in Reconstructed Tissue
A cancer recurrence in the area of a reconstructed breast is a return of the original disease, not a new cancer arising from the implant or transferred tissue. This local recurrence originates in the small amount of glandular tissue, skin, or lymphatic channels that remain after the mastectomy. Microscopic residual tissue may persist near the chest wall or in the skin flaps.
The risk of recurrence is directly tied to characteristics of the original tumor, such as its size, stage, and lymph node involvement. The recurrence rate after mastectomy and reconstruction is low, typically two to five percent. Cancer cells usually return as nodules in the skin or subcutaneous tissue, the most common site of local recurrence.
Recurrence can also manifest as a chest wall recurrence, found in the muscles or deeper tissues beneath the reconstructed breast. This deep recurrence often has a more guarded prognosis than a superficial skin recurrence. Autologous tissue flaps consist of fat and skin transferred from another body site, meaning the recurrence happens only in the remaining native breast area.
Detection and Surveillance Methods
Monitoring a reconstructed breast requires vigilance from the patient and specialized clinical evaluation. Local recurrence is most frequently found through the patient’s own physical awareness or during a routine physical exam. Patients should become familiar with the “new normal” of their reconstructed area and immediately report any persistent changes.
Key symptoms that warrant medical attention include a new lump or thickening beneath the skin or in the armpit, persistent pain, or changes to the skin such as redness, dimpling, or ulceration. Although scar tissue and fat necrosis are common non-cancerous changes, any new mass should be promptly evaluated with imaging.
Imaging surveillance is individualized and depends on the type of reconstruction. Ultrasound is frequently used to investigate palpable masses in autologous tissue flaps. Magnetic resonance imaging (MRI) is a sensitive tool that can detect deep or occult recurrences. Mammography is often challenging, but specialized views may be used to image any remaining glandular tissue.
Implant-Associated Lymphoma (BIA-ALCL)
A distinct risk associated with breast implants is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This is a rare cancer of the immune system, a T-cell lymphoma, and is not a form of traditional breast cancer. BIA-ALCL develops in the scar capsule that naturally forms around the implant.
This condition is strongly linked to implants with a textured surface, though it can occur with any type. The risk is estimated to be low, but the association led the Food and Drug Administration (FDA) to classify BIA-ALCL as a risk associated with all breast implants. Symptoms typically appear years after placement, averaging around eight to ten years.
The most common sign is the sudden, late-onset enlargement or swelling of the breast due to a build-up of fluid (seroma) around the implant. Other symptoms include a lump near the implant or in the armpit, pain, or hardening. Diagnosis is confirmed by analyzing the seroma fluid or surrounding tissue for specific markers, like the CD30 protein. Treatment involves surgical removal of the implant and the entire surrounding capsule if BIA-ALCL is confined to that area.