title: Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions.
abstract: OBJECTIVE
  To determine the incidence of capsular contracture (CC) requiring revisional surgery in patients receiving postoperative radiotherapy (RT) or no RT following mastectomy and immediate breast reconstruction.
  
  
  METHODS
  One hundred and seventy-eight immediate breast reconstructions performed at the Cambridge Breast Unit between 1.1.2001 and 31.12.2005 were identified. RT was delivered using a standard UK scheme of 40 Gray in 15 fractions over 3 weeks. The influence of hormones and chemotherapy as well as postoperative RT on time to development of severe CC after implant-based reconstruction was explored in univariate and multivariate analysis.
  
  
  RESULTS
  One hundred and ten patients had implant-based reconstructions with a median follow-up of 51 months. In the RT group (41 patients), there were 8 patients with severe CC requiring revisional surgery, a crude rate of 19.5%, with actuarial rates of 0%, 5%, 5%, 21%, 30% and 30% at 1, 2, 3, 4, 5 and 6 years follow-up. In the unirradiated group, there were no cases of severe CC. This difference is highly significant (p<0.001). Hormones and chemotherapy were not significantly associated with severe CC.
  
  
  CONCLUSIONS
  This series showed a significantly higher rate of severe CC with postoperative RT. This finding has important clinical implications, when counselling patients for immediate breast reconstruction.
authors.affiliation: Oncology Centre, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whitfield
authors.forename: Gail
authors.initials: G
authors.lastname: Horan
authors.forename: Michael S
authors.initials: MS
authors.lastname: Irwin
authors.forename: Charles M
authors.initials: CM
authors.lastname: Malata
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Wishart
authors.forename: Charles B
authors.initials: CB
authors.lastname: Wilson
mesh_terms: D000328:Adult; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003286:Contracture / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy; D008875:Middle Aged; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012086:Reoperation; D035441:Thoracic Wall / Q000528:radiation effects*