Breast Cancer Hormone Therapy Modulates Breast Implant Capsular Contracture

Chawla M, et al. Plast Reconstr Surg Glob Open, 2025. PMID: 40765683

Key takeaways

• Tamoxifen use at the time of implant placement was associated with lower capsular contracture odds (OR 0.40, P = 0.006).

• Radiation increased capsular contracture odds (OR 3.05, P = 0.002).

• Surgical complications (hematoma and infection) increased odds (OR 2.66, P = 0.04).

• Smooth implants showed lower odds than textured (OR 0.32, P < 0.001).

• No significant impact of subpectoral placement or use of ADM on capsular contracture formation.

Background

Capsular contracture affects ~8%–15% of implant-based reconstructions and often necessitates revision. Estrogen signaling has been implicated in capsule formation; with higher amounts of estrogen increasing the presence of myofibroblasts and collagen surrounding implants. Tamoxifen may have antifibrotic effects resulting in reduced rates of capsular contracture.

Objective

Assess whether concurrent breast cancer hormone therapy—specifically tamoxifen—modulates capsular contracture risk after implant-based reconstruction.

Methods

• Design/setting/LOE: Single-center retrospective case–control of patients undergoing capsulectomy/capsulotomy (Feb 2013–Dec 2021).

• Sample: 914 charts screened; 331 met criteria; mean age at implant 47.4 years.

• Inclusion: Revision after two-stage implant reconstruction (tissue expander → implant). Key exclusions: non–breast cancer, tissue-expander capsulectomy, unverifiable tamoxifen schedule. Tamoxifen exposure was defined as being on active therapy at the time of implant placement.

• Variables: Demographics; implant plane/texture; ADM; radiation, chemotherapy, aromatase inhibitors; postoperative complications. Outcome = capsular contracture at explant (Baker 3–4 noted).

• Statistics: Univariate ORs (chi-square); multivariable stepwise logistic regression; ROC performance. α=0.05.

Results

• Cohort: 331 patients; 236 no contracture (71.3%); 95 high-grade contracture (28.7%). Subpectoral 74.9%; smooth implants 55.3%.

• Primary findings (univariate):

  • Tamoxifen at implantation: OR 0.40 (95% CI 0.12–0.74), P = 0.006.

  • Smooth vs textured surface: OR 0.32 (0.18–0.59), P < 0.001.

  • Radiation: OR 3.05 (1.54–6.02), P = 0.002.

  • CKD: OR 10.33 (1.14–93.66), P = 0.025

  • Surgical complications: OR 2.66 (1.07–6.61), P = 0.04.

• Multivariable (final model): Lower odds with tamoxifen and smooth implants; higher with radiation and longer implant age; ROC AUC 0.7686.

Conclusion

Among breast cancer patients receiving implant reconstruction, concurrent tamoxifen exposure at implantation correlated with reduced capsular contracture risk; radiation, complications and CKD significantly increased risk.

Strengths & limitations

• Multivariable modeling with discrimination assessment (AUC 0.77).

• Retrospective single-center design; outcome grading variability (poor interobserver reliability).

• Confounding by implant era/texture possible and did not account for operative techniques (antibiotic washes, placement or ADM use).

Clinical relevance

For implant-based reconstruction in ER+ patients, discuss potential tamoxifen-associated protection against contracture at the time of implantation and counsel on radiation-related risk; optimize techniques to minimize postoperative complications.