Recurrence of Subglandular Breast Implant Capsular Contracture: Anterior versus Total Capsulectomy

Abstract

The objective of this study was to determine whether the type of capsulectomy, anterior or total, affects the recurrence of capsular contracture around subglandular silicone-gel breast implants. A retrospective analysis was performed of patients who underwent either anterior or total capsulectomy for Baker grade 3 or 4 subglandular capsular contracture in our unit. All patients were invited to a review clinic where their capsular status was assessed. There were 100 anterior- disc capsulectomies in 60 patients between 1988 and 1997 and 99 total capsulectomies in 60 patients between 1990 and 1998. The follow-up in the former group was a median of 7 years and mean 6.9 years, compared with median 2.5 and mean 3.1 years in the latter group. Eighty-six percent of the implants removed from both groups at capsulectomy were smooth-walled gel-filled implants. Sixty-nine breasts in the anterior group received textured gel implants at capsulectomy; the remaining 31 received polyurethane-coated Meme implants. In the total capsulectomy group, all but two breasts (one patient) received textured gel implants. After review, the capsular status was known in 80 percent of the anterior and 92 percent of the total capsulectomy group. The review clinic found eight new contractures in five patients to have developed in the anterior compared with none in the total group. Recurrent contractures affected 50 percent of patients (46 percent of breasts) in the anterior and 11 percent of patients (10 percent of breasts) in the total capsulectomy group. Kaplan-Meier survival analysis was applied to the data. By including only patients who received textured gel implants at capsulectomy, the Logrank found a statistical difference between the two treatment groups (0.01 < p < 0.5). We believe that this study provides some evidence that total capsulectomy for subglandular silicone breast implant capsular contracture results in a lower capsular recurrence than anterior- disc capsulectomy. The pattern and risk of recurrence after total capsulectomy and exchange for a modern textured prosthesis appear to approach those following primary augmentation.

Managing Late Periprosthetic Fluid Collections (Seroma) in Patients with Breast Implants: A Consensus Panel Recommendation and Review of the Literature

“…Complica- Volume 128, Number 1 • Late Periprosthetic Fluid Collection tions such as capsular contracture have been shown to occur less frequently in patients with complete versus partial capsulectomy. 31 A complete capsulectomy is recommended based on intraoperative assessment and if technically possible, only to the point that it is surgically prudent and without risk of damage to surrounding structures. If results of cytologic analysis are positive, with a normal or abnormal capsule, recommended treatment options are focused on treating the malignancy.…”

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

“…Caffee 26 reported a recurrence rate of 30.7% after capsulectomy and subpectoral placement of new textured saline implants. Collis and Sharpe 17 reported an 11% recurrence rate after total capsulectomy and a 50% recurrence rate after a partial “anterior disc” capsulectomy, although the follow-up time was shorter for patients treated with total capsulectomy. In 2012, Hester et al 3 reported a 53.4% recurrence rate after traditional capsulectomy.…”

“…Other studies of capsulectomy, all published after 2000, 3,17,25,26 evaluated women with third-generation implants. Costagliola et al 25 reported no recurrences after capsulectomies, but these patients were treated with steroids.…”

“…7 This opinion is based on studies published in the 1970s and 1980s 10–15 evaluating women treated with leaky second-generation silicone gel implants. Although open capsulotomies were commonly performed in the 1980s, 16 this procedure was largely replaced by capsulectomy 17 after investigators implicated bacterial biofilms as a cause of capsular contractures. 18,19 …”

Subpectoral and Precapsular Implant Repositioning Technique: Correction of Capsular Contracture and Implant Malposition

“…However, a total capsulectomy in the submuscular space could be difficult, especially if the capsule is tightly fixed to the chest wall. It may also lead to damage of the surrounding tissue [2]. Aggressive attempts to completely excise in these cases may lead to injury of the intercostal muscle, cause a pneumothorax, or produce major bleeding from intercostal vasculature, which in turn may cause another capsular contracture.…”