Post-Radiation Capsular Contracture in Implant-Based Breast Reconstruction – Management and Outcome

BACKGROUND:Implant based breast reconstruction (IBR) is commonly avoided in the setting of radiation therapy, mainly due to risks of capsular contracture (CC). Nevertheless, as breast reconstruction is becoming more available, more patients receive both IBR and radiotherapy. The dilemma is how to manage CC if it does occur? The goal of this study was to examine the outcome of patients with IBR who developed post-radiation CC and treated with capsulotomy or capsulectomy, with or without fat grafting. METHODS:We reviewed charts of patients who developed CC following alloplastic breast reconstruction followed by radiation therapy, between 2008-2018. The surgical treatment methods for CC were evaluated along with their outcomes. A follow up of at least one year was required. RESULTS:Forty-eight breasts with post-radiation CC, underwent surgical implant exchange with capsular release, of which 15 had combined fat grafting and 33 did not. Overall, 35 (72.9%) breasts showed long-term resolution of CC, of which 24 underwent a single procedure and 11 required an additional fat grafting procedure. Six (12.5%) breasts were offered a consecutive round of fat grafting, and 7 (14.5%) were offered autologous reconstruction due to lack of improvement. Fat grafting increased the success rate by more than 30% when it was initially and consecutively employed. CONCLUSIONS:Post-radiation CC may be treated successfully by secondary procedures, sustaining IBR in over 70% of breasts. Fat grafting may elevate resolution rates even further to 86%. Larger prospective studies are required to validate these findings.