26 Botros M et al. / Recurrent breast cancer and breast implant rupture As for the risk of recurrence, Recht et al. exam- ined factors associated with locoregional failure (LRF) in breast cancer patients from four rand- omized ECOG trials. The patients in this study had undergone mastectomy, chemotherapy with or without tamoxifen, and without radiation. These patients fit the treatment scheme as that of the pa- tient presented herein. At 10 years, the risk of LRF ± distant failure (DF) was reported as 12.9% for pa- tients who had one to three positive nodes at the time of their primary cancer (like the patient pre- sented). It was estimated that 80 % of the patients who had an isolated recurrence and LRF ± DF were diagnosed within 5 years of their primary cancer. The study does not mention the histological types of tumors in this patient population.21 Moreover, the presentation of the tumor recurrence is ac- countable for the clinical outcome of the patient. Willner et al. found that survival rate decreased sig- nificantly if recurrence involved multiple nodules, with a 5-year survival rate of 12%.22 Treatment of locoregional recurrence involves an attempt to clear all local disease. Studies reveal that local control is the most important treatment factor. Interestingly, the optimal local treatment of recurrences requires not only excision but also the use of adjuvant radiotherapy. The use of excision alone has reported failure rates of 57%-76%.22 There are several known and reported compli- cations of breast implants including contracture of tissue surrounding the breast implant and im- plant rupture. Implant rupture is thought to be associated with the age of the implant.23,24 There has also been much speculation about the risks of breast cancer development and the prognosis of diagnosed breast cancer in patients with breast implants. Reasonably, it has been thought that the uncontrolled and ubiquitous phenomenon of gel bleed, which is the diffusion of silicone across the implant’s intact envelope, can result in chronic inflammation. The chronic inflammation would thus increase the potential for cancer develop- ment.25 This theory has not been proven clini- cally in patients. More importantly, studies did find that breast implants impede visualization of breast tissue during screening mammography.25,26 As a result, it is feared that implants may delay diagnosing of breast cancer, leaving the patients with an advanced stage tumor. This delay has been reported by several studies, which confirmed that patients with implants were diagnosed with more advanced breast cancer.26,27 These studies had small patient populations. Two large cohort stud- ies have found that there is no clinical association Radiol Oncol 2012; 46(1): 23-27. that would suggest that patients with implants have worse prognosis upon diagnosis of their can- cer.25,28-30 The Los Angeles study showed that there was no difference in stage of breast cancer between women with breast implants and women without implants.29 The Alberta study showed that there was no significant difference in survival rates be- tween cancer patients who had implants and those without implants.30 Lastly, it is important to point out that these studies have focused on the development of pri- mary breast cancer after cosmetic breast augmen- tation. There is little known about the development of breast cancer in patients who had undergone reconstructive surgery.25 Petit et al. compared 146 breast cancer patients who had undergone recon- structive surgery to 146 matched control patients who underwent mastectomy but not reconstruc- tive surgery. The study showed that patients who had implants were at a lower risk of death due to breast cancer, distant metastasis, and local recur- rence. These patients did not have an increased risk of developing a second primary breast cancer.31 In addition, there is insufficient evidence that silicone breast implants may cause other cancers. Interestingly, there has been one case report in which a primary desmoid tumor was associated with a silicone implant rupture.32To our knowledge this is the first reported case in which a ruptured breast implant appeared at the same time as cancer recurrence. Perhaps the uncontrolled growth of the recurrent cancer may have contributed to the im- plant rupture. References 1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277-300. 2. Toikkanen S, Pylkkänen L, Joensuu H. Invasive lobular carcinoma of the breast has better short- and long-term survival than invasive ductal carci- noma. Br J Cancer 1997; 76: 1234-40. 3. Harake MD, Maxwell AJ, Sukumar SA. Primary and metastatic lobular carci- noma of the breast. Clin Radiol 2001; 56: 621-30. 4. Winchester DJ, Chang HR, Graves TA, Menck HR, Bland KI, Winchester DP. A comparative analysis of lobular and ductal carcinoma of the breast: presentation, treatment and outcomes. J Am Coll Surg 1998; 186: 416-22. 5. Ulukaya E, Karaagac E, Ari F, Oral AY, Adim SB, Tokullugil AH, et al. Chemotherapy increases caspase-cleaved cytokeratin 18 in the serum of breast cancer patients. Radiol Oncol 2011; 45: 116-22. 6. Plesnicar A, Golicnik M, Fazarinc IK, Kralj B, Kovac V, Plesnicar BK. Attitudes of midwifery students towards teaching breast-self examination. Radiol Oncol 2010; 44: 52-6. 7. Pestalozzi B. Portrait of invasive lobular carcinoma of the breast. Eur J Cancer 2009; 45(Suppl 1): 450-1. 8. Hussien MI, Anwar IF, Down SK, Rizvi S, Farooq N, Burger A, et al. Invasive lobular carcinoma of the breast: should this be regarded as a chronic dis- ease? 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