If a patient who had mastectomy and implant reconstruction for T1N0 breast cancer developed a new lesion years later in the axillary tail, should the implant be removed and the chest wall treated or would you consider APBI to spare the implant?  

First we need to confirm the CW recurrence or new primary. The presence of DCIS in axillary twill would favor new primary. Either way, even if the entire chest wall needed to be treated, the implant need not be removed. The patient would need to be counseled about the effects on cosmetic outcome.&nb...

If felt to be a recurrence, I would recommend excision. At times, the consideration for removal of implant is made if close to mass. However, it is often just excised with comprehensive RT. If felt to be a new T1N0 primary, I would excise and consider the chest wall only. APBI can be considered (T1...

While cosmesis is important, it takes a back seat to delivering appropriate treatment. In this post-mastectomy scenario, if the recurrence/new primary is distant to the implant, it may not be necessary to remove the implant. However due to the history of previous cancer and mastectomy, which results...