Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

Abstract

Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.

Effects of Medical Chitosan on Capsular Formation Following Silicone Implant Insertion in a Rabbit Model

“…It is generally believed that the patient's immune system plays a key role in the pathogenesis of capsular fibrosis. Fibroblast, macrophage, and lymphocyte infiltration within the capsule accounts for this reaction [12]. According to previously published reports, fibroblast numbers are increased in accordance with the Baker grade of capsular tissue.…”

Morphologic Features of Magnetic Resonance Imaging as a Surrogate of Capsular Contracture in Breast Cancer Patients With Implant-based Reconstructions

“…In addition to the sample size difference, our measurements did not include the capsular thickness in regions of the implant where a significant overlap was present between the muscle or the surrounding tissue and the capsule. However, we visually observed a distinct difference in the shape of the implant and pectoralis muscles, which led us to investigate the morphologic shape features as a surrogate of CC (18). That investigation demonstrated that a simple measure, such as implant volume, might be insufficient for distinguishing low- from high-grade CC.…”

Polycaprolactone nanofibrous mesh reduces foreign body reaction and induces adipose flap expansion in tissue engineering chamber

“…46,47 When it occurs, the implant is crumpled or fractured, with visible deformity of the implant and breast. 48,49 In silicone chamber, there also exists a thick capsule around the engineered adipose flap, which has been considered to be a major reason limiting the further expansion of the flap mechanically at a later stage. In our study, lower TGF-β expression at the early stage and reduced capsule formation at the late stage were found in the PCL group compared with the control group.…”