Is Scar Tissue Removal Possible After Breast Implant Reconstruction and Radiation?

Last year I had a mastectomy due to multiple malignant phyllodes tumors. Immediate implant reconstruction surgery took place. I underwent 31 days of radiation therapy. Now, I am experiencing sharp, deep pain, and extreme rigidity. I have been informed by my plastic surgeon that I am experiencing capsular contraction, and because radiation further compromises the remaining tissue, is it impossible to remove the capsule. Is this true, or is their hope? If so, are there experts in this area?

Doctor Answers (5)

Capsular contracture post radiation

+2
Dear Papillon01, Sorry to hear about your current result. One of the problems is we really do not have a complete understanding of capsular contracture. After mastectomy there is often a paucity of skin thickness. There are options of revision by capsulectomy and addition of acellular dermal matrix which has been a God send in treatment. Results can be good and recovery usually uneventful. Another option is the use of your own tissues to replace an implant. This can be done as a first procedure or if the acellular dermal matrix fails to achieve a soft breast. I routinely transfer someb of my patient's own fat into the irradiated breast flaps. Your best option is to get reevaluated by your original surgeon. Good luck


Tyler Plastic Surgeon
5.0 out of 5 stars 4 reviews

Reconstruction following radiation is still possible

+2

Most patients who have your history of reconstruction followed by radiation have the same story of hard capsules and painful symptoms.  These can be treated best by changing the reconstruction type--to either a latissimus dorsi flap or another autogenous reconstruction--made with your own tissues.  The flaps add circulation and greatly improve the reconstructive result and the symptoms.

 

These are standard plastic surgical problems--you only need do find an experienced breast reconstructive surgeon whom you like.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon
5.0 out of 5 stars 20 reviews

Radiation therapy and breast implants not a good combination

+2

The incidence of capsular contracture with radiation therapy to breasts with implants is very high as you unfortunately can attest. Your options are very limited because of the changes to the tissue caused by radiation, but there is some evidence that removing the scar capsule (capsulectomy) and using Alloderm grafts can be helpful.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 23 reviews

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Is scar tissue removal possible after breast implant reconstruction and radiation?

+1
Hello!  Thank you for your question.  After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, capsular contracture, and decreased vascularity to the skin/tissue of the area.  Given your complaints of pain, surgical intervention is recommended.  Your options include doing nothing, removal of the implants, removal and replacement with a flap, or excision of scar/capsule and replacement of implants.  

If you are willing to continue with your current implant reconstruction, capsulectomy and implant replacement is a fine plan.  However, there is always the possibility of the scar and contracture to return, at which time, your options will be those above again.  If after this time, you should consider a flap reconstruction.  It is not impossible to remove the scar/capsule, but, unfortunately, in the face of radiation, the issue will continue to develop.  Consult with your plastic surgeon to discuss the various options and what will be the right decision for you.  Best wishes!  

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast Reconstruction

+1

The capsule can probably be removed, but you will likely not be able to put another implant in the same place without the same risks.  Radiation changes all the rules, and scar tissue is so much more common, and devastating to the implant pocket.  Follow closely the advice of your surgeon and if they recommend removal or keeping them in place, follow the advice.  These cases are so individual, only an experienced eye for reconstruction can give the best advice.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.