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

Radiation is considered to be a risk factor for developing capsular contracture in augmented women, but the studies reporting on this subject show conflicting results. In this systematic review we sought to understand the risk of capsular contracture in augmented patients with breast cancer treated with breast conserving surgery and radiotherapy. A search was conducted through PubMed for studies reporting on breast cancer, breast augmentation and radiotherapy, with capsular contracture as our primary outcome. To determine if specific risk factors were significant predictors of the development of capsular contracture, we performed uni- and multivariate analysis. Our search revealed 136 articles, of which 12 were deemed eligible. A total of 237 patients were included in the analysis. Univariate analysis revealed that whole breast irradiation (WBI) was significantly associated with a higher risk of contracture (p <.001), compared to treatment with accelerated partial breast irradiation (APBI). A higher radiotherapy dose regimen was also significantly associated with a risk of capsular contracture (p <.001). When performing the multivariate analysis only the effect of increasing radiation dose remained significant (p <.05). Neither the implant location nor the age of the implant had any significant effect on the development of contracture. In conclusion this review shows that WBI is associated with a higher risk of contracture compared to treatment with APBI. Because of the limitations of the studies included, further studies with larger patient cohorts are needed to establish this correlation and evaluate other potential risk factors.