Overview of Risk Factors and Prevention of Capsular Contracture Following Implant-Based Breast Reconstruction and Cosmetic Surgery: A Systematic Review

Abstract

Capsular contracture is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. PubMed was searched for studies, published from 2015 to 2020, focused on potential risk factors and preventions of capsular contracture (CC) in patients who underwent implant-based breast surgery. A total of 533 articles were identified from PubMed, and 13 articles were selected ultimately for our review after eligibility screening and quality appraisal. Common risk factors of CC include biofilm, surgical site infections (SSI), history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix (ADM), leukotriene (LTE) inhibitors, surgical techniques, and others. Multiple risk factors are proposed to be a component of the pathophysiology of CC. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. While efforts are being undertaken to solve this complication with improved technologies and surgical practices, CC remains to be unsolved. Our objective was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.

Unveiling the Enigma: Exploring capsular contracture–Unraveling its link with autoimmune disorders and comprehensive examination of predisposing factors

“…Acellular dermal matrix, leukotriene (LTE) inhibitors, surgical procedures, antibiotic prophylaxis or irrigation, and other interventions all helped to lower the incidence of CC. 20 …”

Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion

“…This may be in line with many other studies that have demonstrated a positive correlation between the degree of capsular contracture and age or time after irradiation. 29 30 Older patients seem to have more severe capsular contracture than younger patients, and radiotherapy-induced capsular contracture tends to aggravate over time owing to radiation-induced irreversibility. Therefore, appropriate surgical intervention is critical for patients with more progressive fibrotic changes.…”

Immunomodulation of Acellular Dermal Matrix Through Interleukin 4 Enhances Vascular Infiltration

“…Capsular contracture in implant-based breast reconstruction can be a significant complication, sometimes necessitating an additional surgical procedure 36 . However, the current clinical evidence shows that the use of ADM can effectively reduce the incidence of capsular contracture 37 .…”