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Top Line: Should you use hypofractionated whole breast radiation for women with breast implants?
The Study: Well should you? The big concern for any woman receiving whole breast radiation with an implant in place is the risk of capsular contracture. After mastectomy, the implant complication rate with radiation is in the 15-20% range. This report from MSKCC describes outcomes for 70 women with pre-existing breast implants treated with lumpectomy and adjuvant whole breast radiation. Overall, 25% developed new or worsened capsular contracture at a median of 1.5 years after radiation. But don’t get too wound up by the word contracture. No patient had a recorded implant loss and nearly two-thirds still had good or excellent cosmesis. The majority of contractures were grade 3, which is when the breast is firm and appears “abnormal” but there is no significant pain. Only one patient developed hard, painful grade 4 contracture. Over half of these patients received hypofractionated radiation (2.65 Gy x 16 = 42.4 Gy) and over 80% had a boost. In multivariable analysis, neither hypofractionation nor boost (nor any other factor) was associated with a risk of contracture.
TBL: Hypofractionated whole breast radiation, even with a boost, has acceptable cosmetic outcomes for women with pre-existing breast implants. | Tadros, Pract Radiat Oncol 2020