The impact of breast cancer on cosmetic breast augmentation outcomes and screening challenges in patients with implants: a literature review

Introduction

Background

Breast augmentation using silicone or saline implants is among the most performed aesthetic surgical procedures globally. According to recent statistics from the International Society of Aesthetic Plastic Surgery, over 1.8 million breast augmentation procedures were conducted worldwide in 2023 alone, reflecting the growing desire for aesthetic enhancement of the female form (1).

Rationale and knowledge gap

While the psychological and psychosocial benefits of breast augmentation are well-documented—ranging from improved body image to increased self-esteem—the potential clinical implications, particularly related to oncologic safety and diagnostic limitations, have attracted increasing scrutiny from the medical community.

One central concern lies in the impact of breast implants on breast cancer detection. Although current evidence suggests that breast implants do not increase the incidence of breast cancer (2,3), they can present significant barriers to early diagnosis. This is primarily due to their ability to obscure mammographic views, especially when placed in the subglandular position (4,5). Techniques such as the Eklund method, which involves the manual displacement of the implant during mammographic imaging, have been developed to improve visualization (6). Despite such adaptations, variability in application across healthcare systems continues to limit the consistency and reliability of screening outcomes (7,8).

The emergence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare T-cell lymphoma that occurs in the fibrous capsule surrounding breast implants, has added complexity to the conversation. Officially recognized by the World Health Organization in 2016 (9), BIA-ALCL has been primarily linked to textured implants and typically presents years after implantation with symptoms such as seroma or palpable mass (10). Timely diagnosis is crucial, involving imaging, CD30⁺/ALK^– cytology, and often surgical management through en bloc capsulectomy (11,12).

Another critical area is the impact of postmastectomy radiation therapy (PMRT) on implant-based reconstructions. Historically considered a contraindication, PMRT is now compatible with implant reconstruction (13). These developments have significant implications for multidisciplinary breast cancer care and patient quality of life.

Objective

This literature review aims to synthesize the current state of evidence regarding: the effect of breast implants on breast cancer incidence and prognosis; the diagnostic challenges posed by implants during screening; and the epidemiology, diagnosis, and management of BIA-ALCL. We present this article in accordance with the Narrative Review reporting checklist (available at https://tbcr.amegroups.com/article/view/10.21037/tbcr-25-22/rc).

Methods

A search was conducted in March 2025 across PubMed, Cochrane Library, and SciELO. Studies published between January 1990 and February 2025 were considered.

Search strategy

We used the following terms: “Breast cancer” AND “Screening” AND (“Breast implants” OR “Breast augmentation” OR “Breast reconstruction”) written in English or Portuguese, and involving human subjects.

Inclusion criteria

• Clinical studies, reviews, and meta-analyses;
• Focused on breast cancer screening, outcomes, or BIA-ALCL in implant patients;
• Addressed imaging strategies, oncologic prognosis, or treatment.

Exclusion criteria

• Animal studies;
• Editorials, case reports, and commentaries;
• Studies lacking sufficient methodological quality or relevant data.

Study selection and data charting

Two reviewers independently screened all titles and abstracts. Full texts were assessed when eligibility was unclear. A standardized data charting form was used to extract publication year, study design, population characteristics, implant types, imaging modalities, cancer detection outcomes, and BIA-ALCL management strategies. Table 1 summarizes the search strategy.

Synthesis of evidence

We organized findings into three main themes: cancer incidence and prognosis; imaging limitations and screening strategies; and BIA-ALCL epidemiology and management.

Results

From 447 initial records, 62 met eligibility criteria. This included 20 systematic reviews/meta-analyses, 37 observational or cohort studies, and 5 randomized controlled trials.

Cancer incidence and prognosis

Numerous large-scale cohort studies confirm no elevated risk of breast cancer in women with cosmetic implants (2,3). A U.S.-based retrospective cohort study involving over 18,000 women found comparable tumor stages and survival outcomes between implant recipients and control groups (7). Tumor biology did not differ significantly by implant status.

Imaging limitations and diagnostic strategies

Implants present mechanical barriers that limit mammographic sensitivity, especially when located subglandularly (4,5). These limitations can delay diagnosis, as tumors may be masked or require additional imaging. The Eklund technique improves tissue visualization and should be standard practice (10,11). Magnetic resonance imaging (MRI) and ultrasound are particularly valuable for patients with dense breast tissue or inconclusive findings (12,13).

False positives and unnecessary biopsies are also more frequent in augmented patients, according to recent analyses. This can result in emotional distress and increased healthcare utilization. Imaging protocols should account for implant position, patient risk profile, and breast density.

PMRT

Historically viewed as a contraindication for implant-based reconstruction, PMRT has evolved. Newer strategies, including the delayed-immediate approach and protective lipofilling, help preserve outcomes in irradiated patients (14). These protocols should be discussed during multidisciplinary planning.

BIA-ALCL: diagnosis, treatment, and epidemiology

BIA-ALCL is rare, with a latency period of 7–10 years post-implantation (6,15). The disease typically presents as delayed seroma or capsular mass. Diagnosis involves CD30⁺ protein cytology and positron emission tomography-computed tomography staging (8). National Comprehensive Cancer Network guidelines recommend surgical excision with en bloc capsulectomy and implant removal for localized disease (9). Advanced cases may require chemotherapy.

Recent epidemiological studies indicate underreporting, especially in low-resource. Surveillance is critical, and registries are improving global data collection. However, long-term follow-up protocols remain inconsistent (16).

Discussion

Our review reinforces that breast implants do not increase breast cancer risk but introduce diagnostic complexities. While mammography remains the frontline screening tool, its efficacy is reduced in the presence of implants. Adjunct modalities like MRI and ultrasound improve diagnostic sensitivity and should be considered, especially in women with dense breasts or high risk. The use of the Eklund technique is vital for optimizing mammographic outcomes. Despite its effectiveness, the technique is underutilized due to lack of training and awareness. Broader implementation could significantly reduce false negatives in augmented populations (17,18).

The emergence of BIA-ALCL as a recognized pathology has highlighted the need for vigilant surveillance. Although uncommon, its potential severity requires that all plastic surgeons discuss this risk during preoperative counseling. Global practices regarding implant texture vary significantly due to diverse cultural and regulatory factors, underscoring the complexity of this aspect. These evolving considerations emphasize the need for continued research and updated guidelines to inform best practices in implant selection and patient management. Surgeons should consider using smooth implants when appropriate, and national societies should continue promoting BIA-ALCL education (19,20).

International disparities in diagnosis and treatment access remain problematic. Resource-limited countries face significant barriers to implementing screening adaptations and standardized oncologic protocols. Global collaboration is needed to establish universal guidelines and expand access to high-quality care (20).

PMRT, once considered incompatible with implants, can now be managed successfully with modern reconstructive protocols. This shift allows more patients to access implant-based reconstruction without compromising cancer therapy. Patient-centered care is paramount. Individualized screening schedules, shared decision-making, and education about risks and symptoms are essential. Further research should focus on long-term follow-up and the psychosocial impact of implant-associated oncologic care (21).

Despite the comprehensive nature of this review, several limitations warrant consideration. Firstly, our search was restricted to studies published in English or Portuguese, which may have limited the inclusion of relevant research from other linguistic regions and potentially introduced a language bias. Secondly, a formal quality assessment of the included evidence was not performed, and the discussion regarding potential biases and heterogeneity across the reviewed studies is acknowledged as a limitation. The inherent variability in reporting standards and study designs among the included literature, particularly concerning detailed imaging protocols and long-term follow-up data for BIA-ALCL, posed challenges in synthesizing fully harmonized conclusions. Furthermore, as a literature review, this manuscript relies on previously published data without statistical pooling, and thus, it is constrained by the limitations of the original studies, including potential biases or confounding factors not addressed in our synthesis.

Conclusions

Breast implants do not increase breast cancer risk but can obscure imaging and delay diagnosis. The Eklund technique, MRI, and ultrasound are critical tools to address this. BIA-ALCL, though rare, presents a serious long-term risk, particularly with textured implants. Surgeons and patients must remain informed and vigilant.

New reconstructive strategies and evolving PMRT protocols are expanding the eligibility for implant-based reconstruction in oncologic settings. Multidisciplinary care, patient education, and consistent long-term follow-up are vital for safe and effective outcomes.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tbcr.amegroups.com/article/view/10.21037/tbcr-25-22/rc

Peer Review File: Available at https://tbcr.amegroups.com/article/view/10.21037/tbcr-25-22/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tbcr.amegroups.com/article/view/10.21037/tbcr-25-22/coif). The authors have no conflicts of interest to declare.

Ethical Statement:The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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