Implant-based breast augmentation is one of the most frequently performed operations in plastic surgery worldwide, for aesthetic and reconstructive reasons. Capsular fibrosis is the most common long-term foreign body response after breast implant augmentation.
OBJECTIVE:
To compare the occurrence of capsular contracture in aesthetic and reconstructive-cancer patients, including those patients who received radiotherapy prior to breast reconstruction with implants.
METHODS:
We conducted a retrospective evaluation of 319 patients who underwent breast implant revision between Jan 2000 and Oct 2016. The patient group was comprised of 175 reconstructive-cancer patients and 144 patients who underwent operation for aesthetic reasons. The occurrence of capsular fibrosis, other complications and the time-period between implantation of breast implants and revision surgery (TP) was analyzed.
RESULTS:
For all 319 patients the mean TP was 7.9 years (7.86±0.45). The most common complication in all revisions was capsular fibrosis (65.1% of all revisions). In aesthetic patients with capsular fibrosis the mean TP was 11.9 years (11.89±0.95, p < 0.001). This mean TP was significantly higher than the mean TP of 6.1 years (6.13±0.56, p < 0.001) in breast cancer patients with capsular fibrosis. Preoperatively irradiated cancer patients had a mean TP of 6.2 years (6.17±0.95), compared to a mean TP of 5.1 years (5.07±0.19, p = 0.051) in non-irradiated cancer patients, which was not significantly different.
CONCLUSIONS:
We found that aesthetic patients exhibit a significantly higher mean TP compared to breast cancer patients, suggesting that reconstructive-cancer patients in general develop capsular fibrosis earlier. Despite the literature, we did not find a significant influence of preoperative radiotherapy on the occurrence of capsular fibrosis in reconstructive-cancer patients. Further clinical studies need to be conducted to identify methods to decrease the risk of developing capsular fibrosis.
FerlayJ, SoerjomataramI, DikshitR, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015;136(5):359–86.
3.
ServickK. Breast cancer. Breast cancer: A world of differences. Science (New York, N.Y.). 2014;343(6178):1452–3.
4.
CookRR, PerkinsLL. The prevalence of breast implants among women in the United States. Current Topics in Microbiology and Immunology. 1996;210:419–25.
5.
RothRS, LoweryJC, DavisJ, WilkinsEG. Quality of life and affective distress in women seeking immediate versus delayed breast reconstruction after mastectomy for breast cancer. Plastic and Reconstructive Surgery. 2005;116(4):992–1002; discussion 1003-5.
6.
RubinoC, FigusA, LorettuL, SechiG. Post-mastectomy reconstruction: A comparative analysis on psychosocial and psychopathological outcomes. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 2007;60(5):509–18.
7.
HarcourtDM, RumseyNJ, AmblerNR, et al. The psychological effect of mastectomy with or without breast reconstruction: A prospective, multicenter study. Plastic and Reconstructive Surgery. 2003;111(3):1060–8.
8.
AgarwalS, KidwellKM, FarbergA, KozlowJH, ChungKC, MomohAO. Immediate reconstruction of the radiated breast: Recent trends contrary to traditional standards. Annals of Surgical Oncology. 2015;22(8):2551–9.
9.
AlbornozCR, MatrosE, McCarthyCM, et al. Implant breast reconstruction and radiation: A multicenter analysis of long-term health-related quality of life and satisfaction. Annals of Surgical Oncology. 2014;21(7):2159–64.
10.
KronowitzSJ, RobbGL. Radiation therapy and breast reconstruction: A critical review of the literature. Plastic and Reconstructive Surgery. 2009;124(2):395–408.
11.
BrooksS, DjohanR, TendulkarR, NutterB, LyonsJ, DietzJ. Risk factors for complications of radiation therapy on tissue expander breast reconstructions. The Breast Journal. 2012;18(1):28–34.
12.
ClemensMW, KronowitzSJ. Current perspectives on radiation therapy in autologous and prosthetic breast reconstruction. Gland Surgery. 2015;4(3):222–31.
13.
JagsiR, JiangJ, MomohAO, et al. Complications after mastectomy and immediate breast reconstruction for breast cancer: A claims-based analysis. Annals of Surgery. 2016;263(2):219–27.
14.
ErikssonM, AnvedenL, CelebiogluF, et al. Radiotherapy in implant-based immediate breast reconstruction: Risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Research and Treatment. 2013;142(3):591–601.
15.
AracoA, CarusoR, AracoF, OvertonJ, GravanteG. Capsular contractures: A systematic review. Plastic and Reconstructive Surgery. 2009;124(6):1808–19.
16.
TaylorCW, HorganK, DodwellD. Oncological aspects of breast reconstruction. Breast (Edinburgh, Scotland). 2005;14(2):118–30.
17.
McCarthyCM, MehraraBJ, RiedelE, et al. Predicting complications following expander/implant breast reconstruction: An outcomes analysis based on preoperative clinical risk. Plastic and Reconstructive Surgery. 2008;121(6):1886–92.
18.
SpearSL, BoehmlerJH, BogueDP, MafiAA. Options in reconstructing the irradiated breast. Plastic and Reconstructive Surgery. 2008;122(2):379–88.
19.
HeadonH, KasemA, MokbelK. Capsular contracture after breast augmentation: An update for clinical practice. Archives of Plastic Surgery. 2015;42(5):532–43.
20.
WolframD, RainerC, NiedereggerH, PizaH, WickG. Cellular and molecular composition of fibrous capsules formed around silicone breast implants with special focus on local immune reactions. Journal of Autoimmunity. 2004;23(1):81–91.
21.
ForsterNA, KunziW, GiovanoliP. The reoperation cascade after breast augmentation with implants: What the patient needs to know. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 2013;66(3):313–22.
22.
BakerDW, TsaiY-T, WengH, TangL. Alternative strategies to manipulate fibrocyte involvement in the fibrotic tissue response: Pharmacokinetic inhibition and the feasibility of directed-adipogenic differentiation. Acta Biomaterialia. 2014;10(7):3108–16.
23.
SowaY, YokotaI, ItsukageS, et al. Evaluation of the severity of capsular contracture using elastography after breast implant reconstruction. Clinical Hemorheology and Microcirculation. 2017;66(1):1–6.
24.
SpearSL, BakerJLJR. Classification of capsular contracture after prosthetic breast reconstruction. Plastic and Reconstructive Surgery. 1995;96(5):1119–23. discussion 1124.
25.
BakerJ. Symposium on Aesthetic Surgery of the Breast: Proceedings of the Symposium of the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons and the American Society for Aesthetic Plastic Surgery, 1978.
26.
GrewalNS, FisherJ. Why do patients seek revisionary breast surgery?Aesthetic Surgery Journal. 2013;33(2):237–44.
27.
RoccoN, RispoliC, MojaL, et al. Different types of implants for reconstructive breast surgery. The Cochrane Database of Systematic Reviews. 2016;(5):CD010895.
28.
BarnsleyGP, SigurdsonLJ, BarnsleySE. Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: A meta-analysis of randomized controlled trials. Plastic and Reconstructive Surgery. 2006;117(7):2182–90.
29.
PetersW. Current status of breast implant survival properties and the management of the woman with silicone gel breast implants. Canadian Journal of Plastic Surgery. 2000;8(2):54–67.
30.
Ethical guidelines for publication in Clinical Hemorheology and Microcirculation: Update 2016. Clinical Hemorheology and Microcirculation (2016;63(1):1–2.
31.
ChangDW, BarneaY, RobbGL. Effects of an autologous flap combined with an implant for breast reconstruction: An evaluation of 1000 consecutive reconstructions of previously irradiated breasts. Plastic and Reconstructive Surgery. 2008;122(2):356–62.
32.
ChettaMD, AliuO, ZhongL, et al. Reconstruction of the irradiated breast: A national claims-based assessment of postoperative morbidity. Plastic and Reconstructive Surgery. 2017;139(4):783–92.
33.
WhitfieldGA, HoranG, IrwinMS, MalataCM, WishartGC, WilsonCB. Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions. Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology. 2009;90(1):141–7.
34.
JhaveriJD, RushSC, KostroffK, et al. Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction. International Journal of Radiation Oncology, Biology, Physics. 2008;72(3):859–65.
35.
AschermanJA, HanasonoMM, NewmanMI, HughesDB. Implant reconstruction in breast cancer patients treated with radiation therapy. Plastic and Reconstructive Surgery. 2006;117(2):359–65.
36.
ChaoAH, MartinezJC, WobbJ, PovoskiSP. Multivariate preoperative and intraoperative predictors of postmastectomy radiation therapy in patients for whom immediate breast reconstruction is planned. Plastic and Reconstructive Surgery. 2017;139(3):599e–605e.
37.
BarneaY, FriedmanO, AradE, et al. An oncoplastic breast augmentation technique for immediate partial breast reconstruction following breast conservation. Plastic and Reconstructive Surgery. 2017;139(2):348e–57e.
38.
CollierP, WilliamsJ, EdhayanG, KannegantiK, EdhayanE. The effect of timing of postmastectomy radiation on implant-based breast reconstruction: A retrospective comparison of complication outcomes. American Journal of Surgery. 2014;207(3):408–11; discussion 410-1.
39.
ChristensenBO, OvergaardJ, KettnerLO, DamsgaardTE. Long-term evaluation of postmastectomy breast reconstruction. Acta Oncologica (Stockholm, Sweden). 2011;50(7):1053–61.
40.
HirschEM, SethAK, DumanianGA, et al. Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation. Plastic and Reconstructive Surgery. 2012;129(2):354–61.
41.
LeeBT, A AdesiyunT, ColakogluS, et al. Postmastectomy radiation therapy and breast reconstruction: An analysis of complications and patient satisfaction. Annals of plastic surgery. 2010;64(5):679–83.
42.
LamTC, HsiehF, BoyagesJ. The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: A systematic review. Plastic and Reconstructive Surgery. 2013;132(3):511–8.
43.
MomohAO, AhmedR, KelleyBP, et al. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Annals of Surgical Oncology. 2014;21(1):118–24.
