Capsular Contracture After Radiation: How I Treat It

I know a lot of surgeons will tell you that a capsular contracture plus radiation means the implant comes out. But a lot of patients don't want autologous reconstruction (rebuilding the breast with their own tissue), or they aren't candidates for it, and they want to give their implant reconstruction a chance.

I think you often should try.

Radiation causes some changes that happen to most patients:

• Everything becomes a little stiff
• The tissue doesn't heal as well
• It often thins out somewhat

That's important to consider when treating a contracture. Everything in my general approach to treating capsular contracture is still true for radiated patients, but I like to add a few steps.

The first thing I add for my radiated patients is hyperbaric oxygen therapy (HBOT). It can be so useful, because it helps patients heal better, and remember, they have a difficult time healing after radiation. I also find that it helps them form a more normal capsule that's not quite as thick.

HBOT may be covered by insurance if you've had radiation, so it's worth asking about. My patients are usually treated for about two weeks before surgery and at least two weeks after, sometimes up to four.

Radiated capsular contractures tend to have very thin overlying tissue, so I use no heat if at all possible. I remove the capsule with sharp instruments rather than electrocautery, because cautery can cause a lot of healing problems with the overlying skin.

The tissue is very thin, and I don't want to damage the subdermal plexus, the blood supply that sits right under the skin. The capsule still comes out completely. I just do it in a slightly different way.

I'm a huge believer in fat grafting for radiated patients. Bringing healthy tissue into an area that's been damaged by radiation is really beneficial, and it can actually improve some of the radiation changes.

I'm just not a fan of doing it at the same time as the contracture repair. In my practice, I usually recommend fat grafting three to six months before the contracture repair or three to six months after. After is what most of my patients do.

It helps the overall tissue quality, and remember that the radiated side typically has less soft tissue. Radiation shrinks things a little, and fat grafting adds a little back.

Treating a contracture after radiation is very similar to treating one without radiation, just with a few additional steps: hyperbaric oxygen, a gentler technique that protects thin skin, and fat grafting timed separately from the repair.

The traditional teaching is not to use implants in radiated tissue. But a lot of people don't want autologous reconstruction or aren't candidates for it, and I think it's worth giving the implant reconstruction a chance. Contracture surgery after reconstruction is also often covered by insurance. If other parts of your reconstruction need work too, see breast reconstruction revision. More on what causes contracture in the first place, how I keep recurrence low, and capsular contracture after radiation or reconstruction.