What are my options to correct capsular contracture caused by radiation treatment received after a recurrence of breast cancer?

It is very common to get capsular contracture after radiation and implant; depending on how much volume you need for reconstruction, after implant removal, the abdominal tissue via a DIEP free flap will provide the most optimal treatment.   Fat grafting is also reasonable, but will unlikely give you as much live, healthy, fat volume.   

Thank you for your question and I am sorry to hear about the complications you have experienced since your cancer treatment. Capsular contracture and radiation therapy have a close association, unfortunately. The good news is you have options in revision procedures that will restore the look of the breasts and give you more confidence in your body profile. In many cases, patients that have undergone radiation therapy will see better results with flap procedures than they will with implants. I encourage you to make an appointment with a board-certified plastic surgeon that has extensive experience in breast reconstruction, including a variety of flap techniques. I wish you all the best!

There is a higher chance of capsular contracture with radiated tissue, which is why many patients choose a different reconstruction path, like fat grafting. This involves replacing your implants with your own fat. It's normally done over a series of procedures, depending on how big you want your final breast size to be. Because you already have implants expanding your tissue, the implants could be swapped out and replaced with fat in your first procedure. This is a great scenario for your first procedure as the breast tissue is expanded and would better receive the transferred fat with excellent long-term survival rates.

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) The definitive treatment for capsular contracture includes (at a minimum) implant removal/exchange and total capsulectomy. The use of ADM may also be beneficial. If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!Matthew A. DelMauro, M.D.

Your best chance to achieve favorable breast reconstruction result is to have a free flap reconstruction (DIEP or muscle-sparing free TRAM - depending on anatomy and skin requirements). Anything short of that with likely to prolong the suffering and will not deliver the superior result that you will get with microsurgery. Additional benefit is improvement of the stomach that will look similar to the one after tummy tuck. The patient however needs to be healthy to undergo this procedure and have abdomen that have not been violated by previous tummy tuck, or extensive liposuction.

You need to be evaluated by a board certified plastic surgeon. There are several options for radiation induced scar contracture. Using-year-old tissue from the abdomen is a distinct possibility if you are a candidate for this physically. Moving tissue from ear back to include muscle with new blood vessels and good blood supply ( radiation damages blood supply) Is another option that is less invasive but usually requires an implant. Finally, newer techniques include  wrapping an implant with acellular dermal matrix which significantly reduces the capsular contracture rate. This is significantly less invasive than the other procedures. Again, your surgeon should be able to give you the benefits and downside of each procedure and allow you to make a decision.

If you have enough donor site tissue, then autologous tissue reconstruction likely could be your best option. If you could benefit from a tummy tuck, then a DIEP flap could be a nice option. Other areas we take tissue from are the thighs and the buttocks (my least favorite option).  Talk with a plastic surgeon who specializes in both implant and autologous tissue reconstruction so that you can get an unbiased recommendation which fits your body and lifestyle.  Consider going out of state if need be.  Hope this helps!

Managing capsular contracture properly is the same with radiated patients and non-radiated patients if you choose to keep an implant based reconstruction.  It is important to remove the capsule completely, treat for biofilm, and replace your implants with dermal matrix. You also will likely benefit from fat grafting.  If you choose to change to a non-implant reconstruction, there are multiple types of tissue reconstructions that are likely options for you.  You certainly do not need to go this route though if you would like to keep your implant.  Radiation makes your wound healing complications higher, but surgery can still be done with good results.  Consult with a plastic surgeon skilled and experienced with radiation and contractures.  Good luck!