Breast Brachytherapy and Breast Augmentation: Breast Conservation without Capsular Contracture

Capsular contracture is a significant risk (∼55%) for women receiving whole breast irradiation as part of breast conservation therapy for breast cancer in the presence of augmentation mammoplasty. Fear of this complication leads approximately half of augmented women to have mastectomy for early stage breast cancers despite a high personal priority on appearance. Breast brachytherapy exposes only a tiny fraction of the surface area of the implant to radiation, and has the potential to markedly reduce or eliminate capsular contracture as an issue in these women. Catheter insertion techniques that reliably cover the target volume while preventing inadvertent implant puncture are described. Radiation dose to skin, uninvolved breast, ribs, lung, heart, and the silicone or saline implant is minimized. Our fifteen year experience of partial breast irradiation in augmented women demonstrates excellent tumor control, cosmesis, and quality of life. If the clinical outcomes continue to remain favorable, breast brachy may become the breast-conserving treatment of choice for breast cancer patients with augmentation.