Advances on Capsular Contracture—Prevention and Management Strategies: A Narrative Review of the Literature

Abstract

Background: Capsular contracture (CC) is the most relevant complication of both aesthetic and reconstructive breast implant surgery. For many years, experimental and clinical trials have attempted to analyze CC risk factors, clinical features, and appropriate management strategies. It is commonly accepted that a multifactorial etiology promotes CC development. However, the heterogeneity in patients, implants and surgical techniques make it difficult to suitably compare or analyze specific factors. As a consequence, discordant data are present in literature, and a true systematic review is often limited in its conclusions. Hence, we decided to present a comprehensive review of current theories on prevention and management strategies, rather than a specific “solution” to this complication. Methods: The PubMed database was searched for literature regarding CC prevention and management strategies. Pertinent articles in English, published before December 1, 2022, were compared with selection criteria and eventually included in this review. Results: Through the initial search, 97 articles were identified, of which 38 were included in the final study. Several articles explored different medical and surgical preventive and therapeutic strategies, showing numerous controversies on appropriate CC management. Conclusions: This review provides a clear overview of the complexity of CC. The wide variety of clinical situations in term of patients, implants, and surgical techniques prevent the standardization of CC management strategies. By contrast, a patient-customized approach should be preferred, and different strategies should be considered depending on the specific case. Further research is desirable to better ascertain evidence-based protocols with regard to CC prevention and treatment.

Augmentation Rhinoplasty and Centrofacial Lipofilling: Our Experience (Arcl)

“…[17] In the field of facial cosmetic procedures, this approach is a key tool for achieving personalized and culturally sensitive results for different patients. [27][28][29][30][31][32] Moreover, according to our experience, lipofilling associated with rhinoplasty promotes antiinflammatory effects, aiding in facial recovery and optimizing the overall outcome for enhanced patient well-being. [11][12][13][14] Our study retrospectively analyzed patients who underwent open augmentation Rhinoplasty and Centrofacial Lipofilling (ARCL) in Rio de Janeiro between January 2019 and December 2022.…”

Stromal-cellular remodeling of breast tissue after silicone implant damage

“…There are works in which it is shown that macrophages loaded with silicone play the main (central) role, stimulating fibroblasts to collagenogenesis and thus contribute to the development of capsular contracture [18,24]. Macrophages in culture can be stimulated by silicone to release interleukin-1, which is a pro-inflammatory cytokine that plays an important role in fibroblast proliferation and differentiation [18,42].…”

A Histological Evaluation of the Efficiency of Using Periprosthetic Autologous Fat to Prevent Capsular Contracture Compared to Other Known Methods—An Experimental Study

“…Capsular contracture appears to be directly impacted by factors such as the implant’s content (silicon or a saline solution), implant’s placement (submuscular or subglandular), implant’s surface texture (smooth or textured) and bacterial infection. Moreover, patients undergoing more intricate procedures, like breast reconstruction, tend to exhibit higher rates of capsular contracture compared to those undergoing simpler augmentation [ 17 , 18 , 19 ].…”

“…Methods of prevention, apart from those related to implant texture and content, include the techniques used for implant placement, the surgical approach, the placement site and method, the use of drainage, and the wound closure method [ 17 , 20 , 21 ]. Adams et al consider antibiotic prophylaxis to be extremely important, proposing the intraoperative washing of the implant pocket with a triple combination of antibiotics, a procedure proven to be highly effective in preventing capsular contracture [ 22 , 23 ].…”