Breast-oncoplastic surgery, allowing local tumor control and a better cosmetic outcome, is oncologically safe when applied to early-stage breast cancer. Breast cancer recurrence following conservative therapy may occur during the first 5 years after treatment, with a peak incidence after 2 years. Therefore, during the follow-up period, patients undergo a series of ultrasound (US) and mammographic examinations. However, after surgery and radiation therapy, several modifications occur in the treated breast, causing difficulties in image interpretation, especially when local recurrence is suspected. Although not included in routine follow-up, magnetic resonance imaging (MRI) is often used in clinical practice, being considered more sensitive than the conventional imaging examinations in discriminating between postsurgical tissue modifications and tumor recurrence. In this review article, we analyze expected and pathologic breast MRI findings after conservative oncoplastic surgery compared to US and mammographic findings in order to distinguish local recurrence and avoid potential pitfalls in image interpretation.

Keywords:
Breast cancer, Breast oncoplastic surgery, Magnetic resonance imaging, Fat necrosis, Fibrosis, Tumor recurrence
1.
DeSantis C, Siegel R, Bandi P, Jemal A: Breast cancer statistics, 2011. CA Cancer J Clin 2011;61:409-418.
2.
Smith RA, Duffy SW, Tabár L: Breast cancer screening: the evolving evidence. Oncology (Williston Park) 2012;26:471-475, 479-481, 485-486.
3.
Tardioli S, Ballesio L, Gigli S, DI Pastena F, D'Orazi V, Giraldi G, Monti M, Amabile MI, Pasta V: Wire-guided localization in non-palpable breast cancer: results from monocentric experience. Anticancer Res 2016;36:2423-2427.
4.
Mazouni C, Mesnard C, Cloutier AS, Amabile MI, Bentivegna E, Garbay JR, Sarfati B, Leymarie N, Kolb F, Rimareix F: Quilting sutures reduces seroma in mastectomy. Clin Breast Cancer 2015;15:289-293.
5.
Singletary SE: Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 2002;184:383-393.
6.
Pasta V, Monti M, Cialini M, Vergine M, Urciuoli P, Iacovelli A, Rea S, D'Orazi V: Primitive sarcoma of the breast: new insight on the proper surgical management. J Exp Clin Cancer Res 2015;34:72.
7.
Pasta V, Sottile D, Urciuoli P, Del Vecchio L, Custureri F, D'Orazi V: Rare chondrosarcoma of the breast treated with quadrantectomy instead of mastectomy: a case report. Oncol Lett 2015;9:1116-1120.
8.
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227-1232.
9.
Cao JQ, Olson RA, Tyldesley SK: Comparison of recurrence and survival rates after breast-conserving therapy and mastectomy in young women with breast cancer. Curr Oncol 2013;20:593-601.
10.
Martin AM, Meyricke R, O'Neill T, Roberts S: Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer - a classification tree approach. BMC Cancer 2006;6:98.
11.
Follacchio GA, Monteleone F, Anibaldi P, De Vincentis G, Iacobelli S, Merola R, D'Orazi V, Monti M, Pasta V: A modified sentinel node and occult lesion localization (SNOLL) technique in non-palpable breast cancer: a pilot study. J Exp Clin Cancer Res 2015;34:113.
12.
Pleijhuis RG, Graafland M, De Vries J, Bart J, de Jong JS, van Dam GM: Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions. Ann Surg Oncol 2009;16:2717-2730.
13.
Amabile MI, Mazouni C, Guimond C, Sarfati B, Leymarie N, Cloutier AS, Bentivegna E, Garbay JR, Kolb F, Rimareix F: Factors predictive of re-excision after oncoplastic breast-conserving surgery. Anticancer Res 2015;35:4229-4234.
14.
Houssami N, Morrow M: Margins in breast conservation: a clinician's perspective and what the literature tells us. J Surg Oncol 2014;110:2-7.
15.
Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, Hantel A, Henry NL, Muss HB, Smith TJ, Vogel VG, Wolff AC, Somerfield MR, Davidson NE; American Society of Clinical Oncology: Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013;31:961-965.
16.
Emens LA, Davidson NE: The follow-up of breast cancer. Semin Oncol 2003;30:338-348.
17.
Painter TJ, Di Pasco PJ, Misra S, Avisar E: Effect of magnetic resonance imaging on breast conservation therapy versus mastectomy: a review of the literature. Int J Surg Oncol 2011;2011:428653.
18.
Piper M, Peled AW, Price ER, Foster RD, Esserman LJ, Sbitany H: Mammographic changes after oncoplastic reduction mammoplasty. Ann Plast Surg 2015;Epub ahead of print.
19.
Chansakul T, Lai KC, Slanetz PJ: The postconservation breast: part 2, imaging findings of tumor recurrence and other long-term sequelae. AJR Am J Roentgenol 2012;198:331-343.
20.
Belli P, Costantini M, Romani M, Marano P, Pastore G: Magnetic resonance imaging in breast cancer recurrence. Breast Cancer Res Treat 2002;73:223-235.
21.
Preda L, Villa G, Rizzo S, Bazzi L, Origgi D, Cassano E, Bellomi M: Magnetic resonance mammography in the evaluation of recurrence at the prior lumpectomy site after conservative surgery and radiotherapy. Breast Cancer Res 2006;8:R53.
22.
Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Köbrunner SH, Kaiser WA, Kerin MJ, Mansel RE, Marotti L, Martincich L, Mauriac L, Meijers-Heijboer H, Orecchia R, Panizza P, Ponti A, Purushotham AD, Regitnig P, Del Turco MR, Thibault F, Wilson R: Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 2010;46:1296-1316.
23.
Guo Y, Cai YQ, Cai ZL, Gao YG, An NY, Ma L, Mahankali S, Gao JH: Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging. J Magn Reson Imaging 2002;16:172-178.
24.
Taboada JL, Stephens TW, Krishnamurthy S, Brandt KR, Whitman GJ: The many faces of fat necrosis in the breast. AJR Am J Roentgenol 2009;192:815-825.
25.
Tan PH, Lai LM, Carrington EV, Opaluwa AS, Ravikumar KH, Chetty N, Kaplan V, Kelley CJ, Babu ED: Fat necrosis of the breast: a review. Breast 2006;15:313-318.
26.
Dolan R, Patel M, Weiler-Mithoff E, Mansell J, Stallard S, Doughty JC, Romics L: Imaging results following oncoplastic and standard breast conserving surgery. Breast Care (Basel) 2015;10:325-329.
27.
Chala LF, de Barros N, de Camargo Moraes P, Endo E, Kim SJ, Pincerato KM, Carvalho FM, Cerri GG: Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings. Curr Probl Diagn Radiol 2004;33:106-126.
28.
Cho SH, Park SH: Mimickers of breast malignancy on breast sonography. J Ultrasound Med 2013;32:2029-2036.
29.
Atasoy MM, Oren NC, Ilica AT, Güvenç İ, Günal A, Mossa-Basha M: Sonography of fat necrosis of the breast: correlation with mammography and MR imaging. J Clin Ultrasound 2013;41:415-423.
30.
Kerridge WD, Kryvenko ON, Thompson A, Shah BA: Fat necrosis of the breast: a pictorial review of the mammographic, ultrasound, CT, and MRI findings with histopathologic correlation. Radiol Res Pract 2015;2015:613139.
31.
Ayyappan AP, Crystal P, Torabi A, Foley BJ, Fornage BD: Imaging of fat-containing lesions of the breast: a pictorial essay. J Clin Ultrasound 2013,41:424-433.
32.
Ganau S, Tortajada L, Escribano F, Andreu X, Sentís M: The great mimicker: fat necrosis of the breast-magnetic resonance mammography approach. Curr Probl Diagn Radiol 2009;38:189-197.
33.
Santamaría G, Velasco M, Bargalló X, Caparrós X, Farrús B, Luis Fernández P: Radiologic and pathologic findings in breast tumors with high signal intensity on T2-weighted MR images. Radiographics 2010;30:533-548.
34.
Amabile MI, Monti M, Merola R, Frusone F, D'Orazi V, Pasta V: Nipple-sparing mastectomy in patients with preoperative diagnosis of non-invasive breast carcinoma. A single-center experience. Anticancer Res 2016;36:779-783.
35.
Wazir U, El Hage Chehade H, Headon H, Oteifa M, Kasem A, Mokbel K: Oncological safety of lipofilling in patients with breast cancer: a meta-analysis and update on clinical practice. Anticancer Res 2016;36:4521-4528.
36.
Czerny V: Plastischer Ersatz der Brustdruese durch ein Lipom. Verhandl Deutsche Ges Chir 1895;24:216-217.
37.
Kneeshaw PJ, Lowry M, Manton D, Hubbard A, Drew PJ, Turnbull LW: Differentiation of benign from malignant breast disease associated with screening detected microcalcifications using dynamic contrast enhanced magnetic resonance imaging. Breast 2006;15:29-38.
38.
Pierrefeu-Lagrange AC, Delay E, Guerin N, Chekaroua K, Delaporte T: Radiological evaluation of breasts reconstructed with lipomodeling. Ann Chir Plast Esthet 2006;51:18-28.
39.
Gutowski KA; ASPS Fat Graft Task Force: Current applications and safety of autologous fat grafts: a report of the ASPS fat graft task force. Plast Reconstr Surg 2009;124:272-280.
40.
Chansakul T, Lai KC, Slanetz PJ: The postconservation breast: part 1, expected imaging findings. AJR Am J Roentgenol 2012;198:321-330.
41.
Kwak JY, Kim EK, Chung SY, You JK, Oh KK, Lee YH, Kwon TH, Jung HK: Unilateral breast edema: spectrum of etiologies and imaging appearances. Yonsei Med J 2005;46:1-7.
42.
Libshitz HI, Montague ED, Paulus DD: Skin thickness in the therapeutically irradiated breast. AJR Am J Roentgenol 1978;130:345-347.
43.
Ballesio L, D'Ambrosio I, Ravazzolo N, Angeletti M, Di Pastena F, Tardioli S, Lodise P, Marini M: Skin thickening as unique pathologic sign of an inflammatory breast cancer: a case report and review of the literature. Clin Ter 2011;162:351-354.
44.
Gonzalez EA, Saltzstein EC, Riedner CS, Nelson BK: Seroma formation following breast cancer surgery. Breast J 2003;9:385-388.
45.
Yang Y, Gao E, Liu X, Ye Z, Chen Y, Li Q, Qu J, Dai X, Wang O, Pan Y, Zhang X: Effectiveness of OK-432 (Sapylin) to reduce seroma formation after axillary lymphadenectomy for breast cancer. Ann Surg Oncol 2013;20:1500-1504.
46.
Salemis NS: Breast hematoma complicating anticoagulant therapy: management and literature review. Breast Dis 2012;34:25-28.
47.
Vitug AF, Newman LA: Complications in breast surgery. Surg Clin North Am 2007;87:431-451.
48.
Leung JW: MR imaging in the evaluation of equivocal clinical and imaging findings of the breast. Magn Reson Imaging Clin N Am 2010;18:295-308.
49.
Tse GM, Chaiwun B, Wong KT, Yeung DK, Pang AL, Tang AP, Cheung HS: Magnetic resonance imaging of breast lesion: a pathologic correlation. Breast Cancer Res Treat 2007;103:1-10.
50.
Lee KA, Jochelson MS: Post breast conservation therapy imaging and local recurrence. Q J Nucl Med Mol Imaging 2013;57:332-339.
51.
Bosma SC, van der Leij F, Van Werkhoven E, Bartelink H, Wesseling J, Linn S, Rutgers EJ, van de Vijver MJ, Elkhuizen PH: Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period. Breast Cancer Res Treat 2016;156:391-400.
52.
Quinn EM, Coveney AP, Redmond HP: Use of magnetic resonance imaging in detection of breast cancer recurrence: a systematic review. Ann Surg Oncol 2012;19:3035-3041.
53.
Yin J, Yang J, Han L, Guo Q, Zhang W: Quantitative discrimination between invasive ductal carcinomas and benign lesions based on semi-automatic analysis of time intensity curves from breast dynamic contrast enhanced MRI. J Exp Clin Cancer Res 2015;34:24.
54.
Rinaldi P, Giuliani M, Belli P, Costantini M, Romani M, Distefano D, Bufi E, Mulè A, Magno S, Masetti R, Bonomo L: DWI in breast MRI: role of ADC value to determine diagnosis between recurrent tumor and surgical scar in operated patients. Eur J Radiol 2010;75:e114-123.
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