Preventing capsular contracture with pentoxifylline while under going radiation?

Question

I had a bilateral mastectomy with direct to implant reconstruction. Unfortunately, radiation is being recommended because lymph node involvement was discovered. Has anyone seen success with pentoxifylline(Trental) preventing radiation induced capsular contracture?

Ritu Chopra, MD · Answer

I do use Trental in my patients that have TE in and are going through radiation. I also use Singulair as well as Vit E. This cocktail in some literature has been shown to help and anecdotally in my practice I have seen it first hand. Make sure your radiation oncologist is aware of what you are taking because some may want to hole off until after radiation is done. I hope this helps!!

Matthew A. DelMauro, MD, FACS · Answer

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) I am not familiar with the use of that medication for the prevention of capsular contracture. Best of luck!
Matthew A. DelMauro, M.D.

Mitchell Brown, MD · Answer

There is very little evidence to support a protective effect of pentoxifylline in the face of radiation. The type of implant is often important. If you have a textured highly cohesive gel implant, then these tend to be more resistant to the effects of radiation due to their form stable nature. Smooth round gel implants (which are also excellent devices) can be dealt with by aggressively massaging the implant within the implant pocket. This tries to maintain space for the implant and makes contracture less likely. I recommend to my patients to try to aggressively massage each implant for one minute per breast, three times a day

Richard Zinn, MBChB, MMED, FRACS · Answer

Hi there,
Clearly you are well informed about your reconstruction and ongoing treatment and that is a really good thing.

Unfortunately, not much has conclusively been shown to reduce capsular contraction in the setting of radiation.  The combination of implants and your tissue do not respond well to radiation and often may harden with time.

My best experience has been fat grafting around the implant after radiation and this seems to soften the implant and even reduce pain and early stages of capsule formation.  If you do develop a capsule, changing the implant and removal of the capsule, or replacing the implant with your own tissue may resolve the issue.

Pentoxifylline has been used in a few clinical situations, specifically in peripheral vascular disease to reduce lower limb pain.  It's mechanism of action may be increased blood flow.   The cause of capsular contraction is not clear but increasing blood flow to this area will not necessarily reduce capsular contraction. I have not heard of any evidence to justify its use to reduce capsular or prevent this problem.

Joseph Franklin, MD · Answer

The use of Trental to prevent capsular contractures has been shown to be successful in some cases.    Would let your radiation oncologist know that you are interested in any attempts to prevent contractures.  The use of trental is certainly not going to hurt.   Best of luck during your upcoming radiation treatments.

Preventing capsular contracture with pentoxifylline while under going radiation?

Answers (5)

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