Breast Reconstruction with Implants, Capsular Contracture and Radiotherapy

Nov 17, 2011 by

I found the following study about capsular contracture following breast reconstruction with breast implants and when radiotherapy is used. The study is named: Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fraction and was conducted in 2008.

The study tracks the capsular contracture rate in patients having a breast reconstruction and how the use of radiotherapy, hormones and chemotherapy impact the rate of capsular contracture. The bad news is a significant rate of capsular contracture can be seen if radiotherapy is used, but there were no cases of capsular contracture when chemotherapy and hormones were used.

To the study:

Some interesting points of the study regarding capsular contracture:

  • Capsular contracture can occur in the absence of radiotherapy (RT), but published case series indicate that postoperative RT tends to worsen the degree of CC. This would be expected, as fibrosis is well known to be a late normal tissue effect resulting from RT
  • Capsular contracture (CC) is a well-recognised complication of breast implant surgery undertaken for both cosmetic and reconstructive purposes [1,2]. Capsule formation following such surgery is universal, and all breast implants become surrounded by scar tissue or fibrosis. In some cases, excessive fibrosis and shrinkage of the scar tissue (‘‘capsular contracture”) result in a noticeable distortion of the reconstructed or augmented breast
And the findings- a capsular contracture rate of 19.5% in patients that had radiotherapy and no cases of capsular contracture in patients that did not have radiotherapy; also interesting (and encouraging) was hormones and chemotherapy were not associated with severe capsular contracture. From the report:

Results: One hundred and ten patients had implant-based reconstructions with a median follow-up of 51 months. In the RT group (41 patients), there were 8 patients with severe CC requiring revisional surgery, a crude rate of 19.5%, with actuarial rates of 0%, 5%, 5%, 21%, 30% and 30% at 1, 2, 3, 4, 5 and 6 years followup. In the unirradiated group, there were no cases of severe CC. This difference is highly significant (p < 0.001). Hormones and chemotherapy were not significantly associated with severe CC.

Conclusions: This series showed a significantly higher rate of severe CC with postoperative RT. This finding has important clinical implications, when counselling patients for immediate breast reconstruction

About the patients:  Baseline characteristics of the patients

One hundred and seventy-eight combined mastectomy/immediate breast reconstructions were performed at the Cambridge Breast Unit between January 2001 and December 2005 (Table 2). Fifty-eight non-implant reconstructions were excluded from further analysis leaving 120 implant-based immediate reconstructions in the study group (Fig. 1). Of these, 42 reconstructions in 41 patients were irradiated: 37 patients had a unilateral procedure, one had bilateral procedures (both irradiated), and 3 patients had bilateral procedures with unilateral irradiation. The 78 implant based breast reconstructions (65%) which did not receive postoperative RT were performed in 69 patients: 57 patients had a unilateral procedure, 9 had bilateral procedures (neither irradiated), and 3 patients had bilateral procedures with unilateral irradiation.

The no RT group included six breast reconstructions (in five patients) with previous ipsilateral breast RT and two breast reconstructions (in two patients) with previous mantle RT. Several patients in each group had received prior contralateral breast RT, which was disregarded, as it would be unlikely to impact on ipsilateral CC. A comparison of the indications for the mastectomy and reconstruction in the patients with implants is shown in Table 3. As one would expect, the irradiated group tended to have higher risk disease than the unirradiated group.

Overall 61% (67/110) of patients with implants received hormonal therapy; the proportion was 83% (34/41) in the RT group and 48% (33/69) in the no RT group. Chemotherapy was administered to 43% (47/110) of the study group, with a proportion of 83% (34/41) in the RT group and 19% (13/69) in the no RT group



												
						

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