Impact of hormonal therapy and other adjuvant therapies on contralateral breast volume change after implant-based breast reconstruction

Background Adjuvant therapy after breast surgery, including tamoxifen or aromatase inhibitors, improves the postoperative outcomes and long-term survival of breast cancer patients. The aim of this study was to determine whether volume changes occurred in the contralateral breast during hormonal or other adjuvant therapies.

Methods This study reviewed 90 patients who underwent unilateral breast reconstruction between September 2012 and April 2018 using tissue expanders and a permanent implant after the surgical removal of breast cancer. The volume of the contralateral breast was measured using a cast before the first (tissue expander insertion) and second (permanent implant change) stages of surgery. Changes in breast volume were evaluated to determine whether adjuvant therapy such as hormonal therapy, chemotherapy, and radiation therapy influenced the volume of the contralateral breast.

Results The group receiving tamoxifen therapy demonstrated a significant decrease in volume compared with the group without tamoxifen (−7.8% vs. 1.0%; P=0.028). The aromatase inhibitor–treated group showed a significant increase in volume compared with those who did not receive therapy (−6.2% vs. 4.5%; P=0.023). There were no significant differences between groups treated with other hormonal therapy, chemotherapy, or radiation therapy.

Conclusions Patients who received tamoxifen therapy showed a significant decrease in volume in the contralateral breast, while no significant change in weight or body mass index was found. Our findings suggest that we should choose smaller implants for premenopausal patients, who have a high likelihood of receiving tamoxifen therapy.

Keywords

Surgery, plastic - Reconstructive surgical procedures - Mammaplasty - Hormone antagonists - Tamoxifen

Publication History

Received: 29 May 2018

Accepted: 27 August 2018

Article published online:
03 April 2022

• REFERENCES

• 1 Billon R, Bosc R, Belkacemi Y. et al. Impact of adjuvant antiestrogen therapies (tamoxifen and aromatase inhibitors) on perioperative outcomes of breast reconstruction. J Plast Reconstr Aesthet Surg 2017; 70: 1495-504
• 2 Bouchard-Fortier A, Provencher L, Blanchette C. et al. Prognostic and predictive value of low estrogen receptor expression in breast cancer. Curr Oncol 2017; 24: e106-14
• 3 Davies C, Pan H, Godwin J. et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 2013; 381: 805-16
• 4 Ellis MJ, Coop A, Singh B. et al. Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial. J Clin Oncol 2001; 19: 3808-16
• 5 Ekpo EU, Brennan PC, Mello-Thoms C. et al. Relationship between breast density and selective estrogen-receptor modulators, aromatase inhibitors, physical activity, and diet: a systematic review. Integr Cancer Ther 2016; 15: 127-44
• 6 Cuzick J, Warwick J, Pinney E. et al. Tamoxifen-induced reduction in mammographic density and breast cancer risk reduction: a nested case-control study. J Natl Cancer Inst 2011; 103: 744-52
• 7 Boyd NF, Guo H, Martin LJ. et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007; 356: 227-36
• 8 Schrading S, Schild H, Kuhr M. et al. Effects of tamoxifen and aromatase inhibitors on breast tissue enhancement in dynamic contrast-enhanced breast MR imaging: a longitudinal intraindividual cohort study. Radiology 2014; 271: 45-55
• 9 Nyante SJ, Sherman ME, Pfeiffer RM. et al. Longitudinal change in mammographic density among ER-positive breast cancer patients using tamoxifen. Cancer Epidemiol Biomarkers Prev 2016; 25: 212-6
• 10 Feigelson HS, Jonas CR, Teras LR. et al. Weight gain, body mass index, hormone replacement therapy, and postmenopausal breast cancer in a large prospective study. Cancer Epidemiol Biomarkers Prev 2004; 13: 220-4
• 11 Gambacciani M, Ciaponi M, Cappagli B. et al. Body weight, body fat distribution, and hormonal replacement therapy in early postmenopausal women. J Clin Endocrinol Metab 1997; 82: 414-7
• 12 Ishii N, Ando J, Harao M. et al. Decreased contralateral breast volume after mastectomy, adjuvant chemotherapy, and anti-estrogen therapy, in particular in breasts with high density. J Plast Reconstr Aesthet Surg 2017; 70: 1363-8
• 13 Bulstrode N, Bellamy E, Shrotria S. Breast volume assessment: comparing five different techniques. Breast 2001; 10: 117-23
• 14 Mirzabeigi MN, Nelson JA, Fischer JP. et al. Tamoxifen (selective estrogen-receptor modulators) and aromatase inhibitors as potential perioperative thrombotic risk factors in free flap breast reconstruction. Plast Reconstr Surg 2015; 135: 670e-679e
• 15 Jonat W, Kaufmann M, Sauerbrei W. et al. Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: the Zoladex Early Breast Cancer Research Association Study. J Clin Oncol 2002; 20: 4628-35
• 16 Jakesz R, Hausmaninger H, Kubista E. et al. Randomized adjuvant trial of tamoxifen and goserelin versus cyclophosphamide, methotrexate, and fluorouracil: evidence for the superiority of treatment with endocrine blockade in premenopausal patients with hormone-responsive breast cancer: Austrian Breast and Colorectal Cancer Study Group Trial 5. J Clin Oncol 2002; 20: 4621-7
• 17 Senkus E, Kyriakides S, Penault-Llorca F. et al. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6: vi7-23
• 18 Chen JH, Chang YC, Chang D. et al. Reduction of breast density following tamoxifen treatment evaluated by 3-D MRI: preliminary study. Magn Reson Imaging 2011; 29: 91-8
• 19 Vachon CM, Suman VJ, Brandt KR. et al. Mammographic breast density response to aromatase inhibition. Clin Cancer Res 2013; 19: 2144-53
• 20 den Tonkelaar I, Peeters PH, van Noord PA. Increase in breast size after menopause: prevalence and determinants. Maturitas 2004; 48: 51-7
• 21 Zhou WB, Yin H, Liu XA. et al. Incidence of chemotherapyinduced amenorrhea associated with epirubicin, docetaxel and navelbine in younger breast cancer patients. BMC Cancer 2010; 10: 281
• 22 Choppin SB, Wheat JS, Gee M. et al. The accuracy of breast volume measurement methods: a systematic review. Breast 2016; 28: 121-9
• 23 Kayar R, Civelek S, Cobanoglu M. et al. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer (Auckl) 2011; 5: 43-52
• 24 Salgarello M, Visconti G, Barone-Adesi L. et al. Contralateral breast symmetrisation in immediate prosthetic breast reconstruction after unilateral nipple-sparing mastectomy: the tailored reduction/augmentation mammaplasty. Arch Plast Surg 2015; 42: 302-8
• 25 Mioton LM, Jordan SW, Kim JY. A prospective analysis of dynamic loss of breast projection in tissue expander-implant reconstruction. Arch Plast Surg 2015; 42: 309-15