Position Statement: Breast augmentation and reduction mammoplasty procedures Background

Breast augmentation procedures, performed by plastic, cosmetic and general breast surgeons, have become increasingly popular in recent years. There is a trend for increasing cosmetic surgery tourism, including breast procedures, especially to South-east Asia. The American Society of Aesthetic Plastic Surgery reports a rapid increase in the number of breast implant procedures, with 316,848 cases in 2011 [1]. Breast enlargement surgery is the most commonly performed cosmetic operation in the UK [2] where in 2001, 77% of the 13,000 breast implant operations were estimated to have been performed for cosmetic purposes [3].

The growing incidence of breast augmentation procedures is of concern to BreastSurgANZ for two reasons. Firstly, women with breast implants may be reluctant to participate in the BreastScreen Program because of anxiety about damaging the implants. Secondly, implants may impair early detection of breast cancer.

All patients considering breast augmentation or breast reduction mammoplasty surgery require a comprehensive assessment of underlying breast cancer risk and thorough clinical examination to exclude obvious abnormalities that would need to be fully evaluated. In addition to basic history and examination, some confirmatory breast imaging would be indicated in many cases. While the early detection of breast cancer is the major indication for pre-operative breast imaging, baseline imaging also has other benefits. These include documentation and appropriate investigation of pre-existing parenchymal abnormalities in the breast so as to aid radiological assessment in the setting of future breast cancer screening. The imaging may also be of documentary importance when malignancy occurs in the previously augmented breast [5]. Appropriate imaging may vary depending on the woman’s age, risk factors for breast cancer, breast density and clinical examination findings, but would usually involve mammography, possibly ultrasound and sometimes an MRI (see Table 1).

1. 
   Surgeons performing breast augmentation or reduction mammoplasty should perform comprehensive risk assessment, thorough clinical examination and appropriate imaging.
   
2. 
   General practitioners who are aware that patients are planning to have these procedures performed overseas, or by surgeons who have not met these standards of pre-operative assessment, should complete these assessments themselves, or refer women to an appropriate specialist or breast assessment clinic.
   
3. 
   National societies of plastics and cosmetic surgeons should consider endorsing and promoting these pre-operative requirements for their members who perform breast augmentation and reduction mammoplasty surgery.
   

1. 
   Significant clinical findings including abnormal clinical examination or symptoms. Such findings need full assessment by a breast physician or breast surgeon and may require a biopsy depending on the nature of the problem.
   
2. 
   MRI is specifically indicated only if recommended by a breast specialist. It is only claimable on Medicare for patients within Cancer Australia’s Risk Category 3 [6].
   
3. 
   Defined as:
   

9. 
   Significant family history (Cancer Australia Risk Category 2 or 3) [6];
   

4. 
   Defined as suspicious or inconclusive findings or situations where an assessment is difficult due to anatomical features such as dense breasts.
   

[1] American Society of Aesthetic Plastic Surgery. www.surgery.org/consumers/plastic-surgery-newsbriefs

[3] McIntosh SA, Horgan K. Augmentation mammoplasty: effect on diagnosis of breast cancer. J Plast Reconstr Aesthet Surg. 2008;61(2):124-9. Epub 2007 Nov 26.

cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ. 2013 Apr 29;346:f2399. doi: 10.1136/bmj.f2399.