Treatment of Recurrent Capsular Contracture After Implant Reconstruction

Critical Considerations

In patients with a history of chest wall radiation, tissue expanders/implants are relatively contraindicated due to significantly increased risk of capsular contracture, malposition, poor cosmesis, and implant exposure, as recommended by the National Comprehensive Cancer Network 1
Autologous tissue reconstruction is strongly preferred over implants for patients with radiation history, according to the National Comprehensive Cancer Network 1
If the patient received radiation after the initial implant reconstruction, conversion to autologous tissue flap reconstruction should be strongly considered rather than repeat implant-based surgery, as suggested by the National Comprehensive Cancer Network and the Annals of Oncology 1, 3

Before any surgical intervention, rule out breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) if the patient presents with new effusion/seroma formation, breast swelling or asymmetry occurring years after implantation, or any palpable mass, as recommended by the Journal of Clinical Oncology 4, 5
If effusion is present, perform ultrasound-guided aspiration for cytology with CD30 immunohistochemistry and flow cytometry before proceeding with capsulectomy, as recommended by the Journal of Clinical Oncology 4, 5