Breast Cancer Hormone Therapy Modulates Breast Implant Capsular Contracture

Capsular contracture results in significant morbidity for patients with implant-based breast reconstruction, often requiring revisional operations. Preclinical studies have shown that hormone therapy, such as tamoxifen, may mitigate capsule formation. We analyzed capsular contracture rates in breast cancer patients already on hormone therapy who underwent implant-based reconstruction to determine if hormone therapy reduced these rates.

A retrospective case-control analysis reviewed breast implant surgery patients who underwent capsulectomy/capsulotomy between February 2013 and December 2021. Demographics, cancer treatment, and surgical details were collected. Univariate and multivariable logistic regression analyses were done to compare capsular contracture rates among treatment groups.

Of 331 patients with breast cancer who received capsulectomies for any reason, patients taking tamoxifen at the time of implantation were 40% less likely to have capsular contracture compared with patients who received no tamoxifen therapy (odds ratio [OR] 0.40, P = 0.006). Patients who received radiation therapy had increased odds of capsular contracture (OR 3.05, P = 0.002). Patients who experienced surgical complications, such as hematoma and infection, had increased odds of developing capsular contracture (OR 2.66, P = 0.04). For implant characteristics, there were no significant findings of subpectoral placement or the use of acellular dermal matrix impacting capsular contracture formation.

Patients who underwent implant-based reconstruction had reduced rates of capsular contracture if they received tamoxifen therapy at the time of implantation. These findings support preclinical models that indicate a role for local delivery of hormone therapy around implants to deliberately reduce the occurrence of capsular contracture.