Capsular contracture in patients with prior breast augmentation undergoing breast conserving therapy and irradiation

Serritzlev, Maja Schjølin; Lorentzen, Anne Kathrine; Matthiessen, Louise Wichmann; Hölmich, Lisbet Rosenkrantz

doi:10.1080/2000656x.2020.1755299

Cited by 12 publications

(8 citation statements)

References 29 publications

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“…Decreased physician awareness of breast cancer risk in transmasculine patients after gender-affirming mastectomy may have contributed to a delay in diagnosis for one patient who presented with a subcutaneous mass after chest surgery. Additionally, we expect that the risk of capsular contracture of breast augmentation implants in transfeminine people after RT is comparable to rates in cisgender women ( 28 ). One patient in this cohort underwent breast RT with an implant, receiving 30 Gy to the breast for Hodgkin’s lymphoma.…”

Section: Discussionmentioning

confidence: 98%

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Mansur,

Kempf,

Bitterman

et al. 2023

Front. Oncol.

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IntroductionApproximately 1.6 million people in the US identify as transgender, many of whom undergo gender-affirming medical or surgical therapies. While transgender individuals are diagnosed with cancer at similar rates as those who are cisgender, the impacts of radiation therapy on outcomes of gender-affirming care in transgender, nonbinary, and gender-expansive people with cancer are understudied. We report on the experiences and outcomes of transgender and gender-expansive patients receiving radiation therapy for cancer treatment.MethodsThis study is a multi-institutional retrospective review of patients evaluated from 2005-2019 identified as transgender or gender-expansive in the medical record and treated with radiation therapy.ResultsWe identified 23 patients who received radiation to 32 sites, including 12 (38%) to the brain, head, or neck, 8 (25%) to the thorax, and 7 (22%) to the pelvis. Seventeen patients (74%) received gender-affirming hormone therapy and 13 patients (57%) underwent gender-affirming surgery. Four patients had pelvic radiation before or after gender-affirming pelvic surgery, including two trans women who had pelvic radiation after vaginoplasty. Four patients had radiation to the chest or thorax and gender-affirming chest or breast surgery, including two trans men with breast cancer. Two pediatric patients developed hypopituitarism and hypogonadism secondary to radiation therapy and, as adults, changed their hormone replacement therapy to affirm their transgender identities.DiscussionTransgender people with cancer undergo radiation therapy for a wide range of cancers. Understanding their prior gender-affirming medical or surgical treatments and future gender affirmation goals may identify important considerations for their oncologic care.

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Section: Discussionmentioning

confidence: 98%

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Mansur,

Kempf,

Bitterman

et al. 2023

Front. Oncol.

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“…Capsular contracture often develops later on and increases in frequency even years after reconstruction. Several studies on augmented and reconstructed breast implant patients demonstrated that a longer follow-up period reveals a higher rate of capsular contracture [18][19][20]. Hence, the wide range of incidences reported in the literature is probably influenced by the necessity of a sufficient follow-up duration and the way of performing the assessment, e.g., imaging.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction

Vinsensia,

Schaub,

Meixner

et al. 2024

Cancers

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Our study aims to identify the risk factors and dosimetry characteristics associated with capsular contracture. Methods: We retrospectively analyzed 118 women with breast cancer who underwent PMRT following an IBR between 2010 and 2022. Patients were treated with PMRT of 50.0–50.4 Gy in 25–28 fractions. Capsular contracture was categorized according to the Baker Classification for Reconstructed Breasts. Results: After a median follow-up of 22 months, the incidence of clinically relevant capsular contracture (Baker III–IV) was 22.9%. Overall, capsular contracture (Baker I–IV) occurred in 56 patients (47.5%) after a median of 9 months after PMRT. The rate of reconstruction failure/implant loss was 25.4%. In the univariate analysis, postoperative complications (prolonged pain, prolonged wound healing, seroma and swelling) and regional nodal involvement were associated with higher rates of capsular contracture (p = 0.017, OR: 2.5, 95% CI: 1.2–5.3 and p = 0.031, respectively). None of the analyzed dosimetric factors or the implant position were associated with a higher risk for capsular contracture. Conclusion: Postoperative complications and regional nodal involvement were associated with an increased risk of capsular contracture following breast reconstruction and PMRT, while none of the analyzed dosimetric factors were linked to a higher incidence. Additional studies are needed to identify further potential risk factors.

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“…23,26,28,30,[46][47][48][49][50][51][52][53][54] The most recent study by Lesniak et al 54 in 2020 showed a capsular contracture rate of 34% and recommended that BCT followed by implant-based reconstruction is a safe and cosmetically appealing option for breast cancer patients with previous breast augmentation. Serritzlev et al 55 published a systematic review of capsular contracture rates in augmented patients with breast cancer treated with BCT and radiotherapy and reported a total capsular contracture rate of 22.2%.…”

Section: Discussionmentioning

confidence: 99%

Oncoplastic Augmentation Mastopexy in Breast Conservation Therapy

et al. 2023

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Background Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results and cancer outcomes in the treatment of patients with macromastia or significant ptosis. This study evaluated a series of patients undergoing breast conservation with concomitant oncoplastic-augmentation-mastopexy and a contralateral augmentation-mastopexy. Methods Patients undergoing lumpectomy for breast conservation were identified via a retrospective chart review. Inclusion criteria included patients with ptosis and preexisting breast implants or insufficient breast volume undergoing oncoplastic implant placement/exchange and mastopexy. Demographic characteristics, operative details, and complications were assessed. Results Thirty-four consecutive patients (64 breasts, 4 unilateral procedures) were included in the study. Average age was 51.4 years, average body mass index was 27, and 38.2% were smokers/former smokers. The average operative time was 2.5 hours. Furthermore, 38.2% of patients received chemotherapy, and 82.4% of patients received breast adjuvant radiotherapy. The average length of follow-up was 11.7 months. In the sample that received radiation, the capsular contracture rate was 25%, with a 7.1% contracture revision rate. For the entire group, a total of 8 patients (23.5%) underwent revisions for either positive margins (8.8%), capsular contracture (8.8%), implant loss (2.9%), or cosmetic concerns (2.9%). One patient developed a pulmonary embolism. Conclusions Oncoplastic-augmentation-mastopexy is a safe technique with acceptable complication rates. This technique is best used for breast cancer patients with breast ptosis and a paucity of breast volume or preexisting implants who wish to pursue breast-conserving therapy. The revision rates are acceptable compared with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature, but patients must be clearly counseled on contracture risk.

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Capsular contracture in patients with prior breast augmentation undergoing breast conserving therapy and irradiation

Cited by 12 publications

References 29 publications

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction

Oncoplastic Augmentation Mastopexy in Breast Conservation Therapy

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